Bateman et al developed a simple score for identifying a patient with asthma who is at increased risk for exacerbations. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in South Africa, Europe, Canada and Australia.
Patient selection: asthma on GINA treatment step 3 or 4 AND prebronchodilator FEV1 >= 50% of predicted AND >= 1 exacerbations in the previous year
Outcome: exacerbations within the next 6 months
Parameters:
(1) body mass index in kilograms per square meter
(2) Asthma Control Questionnaire version 5 score (ACQ-5, ranging from 0 to 6, with 6 poor)
(3) postbronchodilator FEV1 as percent of predicted
(4) occasions per day of reliever use (terbutaline or budesonide/formoterol)
(5) GINA treatment step 3 or 4 (out of 5)
|
Parameter
|
Finding
|
Points
|
|
BMI
|
< 30
|
0
|
|
|
>= 30
|
14
|
|
ACQ-5
|
< 1.5
|
0
|
|
|
1.5 to 2.5
|
7
|
|
|
> 2.5
|
13
|
|
postbronchodilator FEV1
|
>= 90% of predicted
|
0
|
|
|
80 to 90%
|
13
|
|
|
< 80%
|
20
|
|
reliever use per day
|
0 or 1
|
0
|
|
|
2 to 4
|
11
|
|
|
> 4
|
26
|
|
GINA treatment
|
step 3
|
0
|
|
|
step 4
|
27
|
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the greater the risk of exacerbations in the next 6 months. A score of 0 was associated with a 5% and a score of 100 with 40%.
• Therapy with budesonide/formoterol was associated with fewer exacterbations compared to fixed dose ICS/LABA therapy.
The curve in Figure 4 is approximated by:
percent =
= (0.003608*((score)^2)) + (0.02462 * (score)) + 5.222
