One approach to determining the severity of a patient's asthma is to measure the amount and type of therapy required to manage the symptoms and the therapeutic side effects that occur. While this approach has several advantages, difficulties and potential pitfalls exist. Furthermore, the scheme needs to be modified as changes in therapeutic drugs and regimens occur.
|
Baseline |
Schedule |
Points |
|---|---|---|
|
Is the patient receiving environmental therapy? |
Yes |
2 |
|
|
No |
0 |
|
Is the patient receiving immunotherapy? |
Yes |
5 |
|
|
No |
0 |
|
beta agonist use |
MDI, 2 puff prn, rescue |
2 |
|
|
MDI, 2 puffs prn, preventive |
1 |
|
|
oral tablet prn |
2 * (use/24 hr) |
|
|
MDI, 2 puffs prn, rescue |
2 * (use/24 hr) |
|
|
nebulized |
5 * (use/24 hr) |
|
|
parenteral |
5 * (use/24 hr) |
|
anticholinergic use |
2 puffs prn |
1 |
|
|
2 puffs scheduled |
1 * (use/24 hr) |
|
cromolyn use |
2 puffs prn |
1 |
|
|
nebulizer, one ampule prn |
2 |
|
|
MDI 2 puffs |
2 * (use/24 hr) |
|
|
nebulizer, one ampule |
3 * (use/24 hr) |
|
Is the Patient Using Daily Meds? |
Schedule |
Points |
|---|---|---|
|
inhaled steroids |
1 puff |
2 * (use/24 hr) |
|
|
2 puffs |
3 * (use/24 hr) |
|
|
3 puffs |
4 * (use/24 hr) |
|
|
4 puffs |
5 * (use/24 hr) |
|
theophylline |
1 tablet 100 mg prn |
1 |
|
|
1 tablet 200 mg prn |
2 |
|
|
routine use, with plasma concentration 0-5 µg/mL |
3 |
|
|
routine use, with plasma concentration 5-10 µg/mL |
4 |
|
|
routine use, with plasma concentration 10-15 µg/mL |
5 |
|
|
routine use, with plasma concentration 15-20 µg/ml |
6 |
|
|
intravenous administration, occasional |
5 |
|
|
continuous intravenous administration in last 3 months |
10 |
|
Has the Patient Used Steroids in Last 3 Months? |
Schedule |
Points |
|---|---|---|
|
oral steroid |
not routine use, but received a "burst" in last 3 months |
10 |
|
|
routine use 1-5 mg/day |
10 |
|
|
routine 5-10 mg/day |
15 |
|
|
routine 10-15 mg/day |
20 |
|
|
routine 15-20 mg/day |
25 |
|
|
routine 20-30 mg/day |
30 |
|
|
routine 30-40 mg/day |
40 |
|
|
routine > 40 mg/day |
50 |
|
on "steroid sparing" anti-inflammatory drug |
Yes |
75 |
|
|
No |
0 |
asthma severity score =
= (baseline points) + (if on daily meds, then daily meds points) + (if on oral steroids in last 3 months, then oral steroids points)
|
Side Effect |
Points |
|---|---|
|
tachycardia |
2 |
|
insomnia |
2 |
|
nausea |
2 |
|
bad dreams |
2 |
|
oral thrush |
5 |
|
seizures |
15 |
|
cushingoid appearance |
25 |
side effects score =
= SUM(points for side effects present)
Interpretation:
• minimum asthma severity score uncertain; probably 1, 2 or 3 based on use of beta-agonists and/or cromolyn sodium on prn basis
• maximum asthma severity score depends on the severity of the asthma and the choice of regimen, but can be over 100 if steroids are used
• minimum side effect score = 0
• maximum side effect score = 53
Potential Limitations:
• variation in experience and expertise of physician in managing asthma
• variation in levels of patient compliance to regimen
• variation between patients in how symptoms correlate with severity of asthma, and how patients respond to an intervention
• variation between observers in scoring
Specialty: Pulmonology
