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A new tool for quantification of asthma severity and treatment response

Published online: October 8, 2019

Whereas asthma “control” refers to the extent to which symptoms and other features of asthma are present in patients, asthma “severity” reflects the level of treatment required to control symptoms and exacerbations. While there are many standardized tools available for the assessment of asthma control, tools for quantification of asthma severity are not widely available.

In a research article recently published in The Journal of Allergy and Clinical Immunology (JACI), Fitzpatrick and colleagues in the National Heart, Lung and Blood Institute’s (NHLBI) Severe Asthma Research Program (SARP) developed a new tool for this purpose in adolescents and adults. The tool, named the ASthma SEverity Scoring System (ASSESS), incorporates four domains of asthma control, lung function, medications, and exacerbations which are summed for a total score of 0 to 20, with higher scores reflecting worse severity. Scale properties, responsiveness, and a minimal important difference (MID) were determined from baseline and 36-month longitudinal data from participants in Phase 3 of SARP (NCT01606826).

The ASSESS tool had acceptable measurement properties and was responsive to changes in quality of life with a MID of 2, with good specificity for outcomes of asthma improvement and worsening. Participants with > 2-point decrease (improvement) in ASSESS scores also had greater improvement in lung function and asthma control after receipt of intramuscular triamcinolone, but these differences were limited to certain phenotypes. Participants treated with biologics also had > 2 -point decrease (improvement) in ASSESS scores overall. Although validations studies are still needed, these results suggest that the ASSESS tool may be useful in epidemiologic and clinical research studies for quantification of treatment response in individual patients and in certain phenotypic groups.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract