Personalized prediction to estimate future risk of severe exacerbations and uncontrolled asthma

Published online: June 21, 2018
 
According to asthma management guidelines, clinicians should assess the current level of control of asthma symptoms alongside the level of guideline-defined future risk of adverse outcomes, whilst taking into account individual patient characteristics, and adjust treatment accordingly. Despite this, currently 50-60% of patients with asthma are not controlled. In clinical practice, current level of asthma control can be easily assessed by validated instruments such as the Asthma Control Questionnaire (ACQ), but it’s difficult to assess individuals’ level of future risk.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Boer et al. developed and validated a personalized risk prediction score enabling clinicians to identify patients with an increased level of future risk, based on patient characteristics and information on early treatment response. Future risk was defined as an ACQ ≥ 1.5 (uncontrolled asthma) at 12 months or the experience of at least one exacerbation during the final six months of follow-up.

The developed personalized risk prediction score includes six easily accessible variables. The risk prediction score is based on sex, current smoking, current and previous Asthma Control Questionnaire (ACQ) scores, and exacerbation(s) in the year prior to the previous visit and since the previous visit (three months previously). By including information on treatment response, exposure to ineffective treatment may be minimized. With the risk prediction score patients are classified into three risk groups: low, intermediate, and high level of risk. In general practice it is not only useful to know which patients have a high risk; the developed risk prediction score classifies almost 60% of the patients as having a low risk. These patients could potentially be safely assessed less frequently or possibly by a practice nurse. This would allow the clinician more time for an extensive review and medication changes in the smaller subgroup of patients in the highest risk category.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Development and validation of personalized prediction to estimate future risk of severe exacerbations and uncontrolled asthma in patients with asthma, using clinical parameters and early treatment response
By Suzanne Boer, Jacob K. Sont, Rik JB. Loijmans, Jiska B. Snoeck-Stroband, Gerben ter Riet, Tjard RJ. Schermer, Willem JJ. Assendelft, Persijn J. Honkoop

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