Asthma Severity Classification Research Articles

Concordance of provider chart notation and guideline-based classification of asthma severity

Objective To evaluate concordance of asthma severity classification via physician chart notation compared with guideline-based criteria in adolescents with diagnosed asthma. Methods Of 284 urban primary care and subspecialty clinic patients aged 13–18 years approached through convenience sampling, 203 surveys were completed (RR = 71.5%). We assessed concordance with sensitivity, specificity, and positive predictive values; overall agreement was evaluated with weighted kappa coefficients and McNemar’s test. Results When considering prescribed treatment according to NAEPP guidelines as a gold standard, the sensitivity for chart notation was very good for intermittent (95%) and less for non-intermittent severity ratings (51%, 58%, and 67% for moderate, severe, and mild persistent asthma, respectively). Overall agreement between chart notation and guideline-based asthma criteria ranged from fair-to-good for mild- (k = 0.36), moderate- (k = 0.44), and severe-persistent severity (k = 0.66). Although the agreement for intermittent severity was highest (k = 0.88), it did not significantly differ by between the two classifications (p ≥ 0.05). Conclusions Concordance for all non-intermittent asthma severity classifications varied between physician and medication-driven 2007 NAEPP guideline classifications in an ethnically diverse urban adolescent patient sample. Physicians should remain aware of the potential for this discordance and refer to the guidelines to classify and treat adolescents with asthma.

Economic Consequences of the Overuse of Short-Acting ß-Adrenergic Agonists in the Treatment of Asthma in Spain.

To determine the relationship between short-acting ß-adrenergic agonist (SABA) overuse and health care resource use and costs in asthma patients in routine clinical practice. A longitudinal retrospective study was conducted in Spanish primary and specialized care centers using the BIG-PAC medical records database. The study population comprised asthma patients ≥12 years of age who attended ≥2 consultations during 2017 and had 1-year follow-up data available. The main outcomes were demographics, comorbidities, medication, and clinical and health care resource use and costs. The relationship between SABA overuse and health care costs and between asthma severity and health care costs was determined. The SABA use IN Asthma (SABINA) study included 39 555 patients, with a mean (SD) age of 49.8 (20.7) years (64.2% female). The Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥3 canisters/y) was 28.7% (95%CI, 27.7-29.7), with a mean of 3.3 (3.6) canisters/y. Overall, 5.1% of patients were prescribed ≥12 canisters/y. SABA overuse was correlated with health care costs (ρ=0.621; P<.001). The adjusted mean annual cost/patient according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity was €2231, €2345, €2735, €3473, and €4243 for steps 1-5, respectively (P<.001). Regardless of asthma severity, SABA overuse yielded a significant increase in health care costs per patient and year (€5702 vs €1917, P<.001) compared with recommended use (<2 canisters/y). SABA overuse yields high costs for the Spanish National Health System. Costs increased with severity of asthma.

Rethinking the relationships between chronic rhinosinusitis and asthma severity

BackgroundPrevious authors have endorsed the need for prospective studies on the effect of treatment of chronic rhinosinusitis on asthma outcomes. Although common pathophysiology for asthma and chronic rhinosinusitis (CRS) has been suggested with the unified airway theory, there is limited data to support the claim and our study does not support the theory. MethodsThis case-control study involved adult patients with a primary diagnosis of asthma in 2019 who were identified from the electronic medical records and divided into those with and without an associated CRS diagnosis. For each asthma encounter, the asthma severity classification, oral corticosteroid (OCS) use and oxygen saturation scores were tabulated and compared between asthma patients with CRS versus control patients after 1:1 matching on age and sex.We determined the association between asthma and chronic rhinosinusitis when evaluating proxies for disease severity: oral corticosteroid use, average oxygen saturation and minimum oxygen saturation. We identified 1321 clinical encounters for asthma associated with CRS and 1321 control encounters for asthma without CRS. ResultsOCS prescription rates at the asthma encounter were not statistically different between the groups (15.3 % and 14.6 %, respectively; p = 0.623). Asthma severity classification was higher in those with CRS versus those without (38.9 % and 25.7 % classified as severe, respectively; p < 0.001).We identified 637 asthma with CRS and 637 matched control patients. There was no significant difference in mean recorded O2 saturations between asthma patients with CRS versus control patients (mean O2 saturations, 97.2 % and 97.3 %, respectively; p = 0.816) nor in minimum oxygen saturation (96.8 % and 97.0 %, respectively; p = 0.115). ConclusionAmong patients with a primary diagnosis of asthma an increasing severity of asthma classification was significantly associated with an associated diagnosis of CRS. In contradistinction, the presence of CRS comorbidity in asthma patients was not associated with increased OCS use for asthma. Similarly, average oxygen saturation and minimum oxygen saturation did not seem differ according to CRS comorbidity. Our study does not support the unified airway theory that suggests a causative relationship between the upper and lower airway.

Adverse perception of cough in patients with severe asthma: a discrete choice experiment.

Asthma symptoms adversely impact quality of life in particular in those with poor disease control. Commonly used patient-reported measures for asthma used to assess asthma control often inadequately capture the impact of cough, despite evidence that cough is one of the most bothersome symptoms for patients with asthma. This study aims to improve our understanding of how patients with asthma perceive cough to better understand its clinical impact. A discrete choice experiment (DCE) was performed in two distinct adult asthma populations; those with severe asthma as defined by Global Initiative for Asthma (GINA) step 4/5 classification and those with moderate asthma (a GINA steps 2 or 3 classification of asthma severity). Choices were highly dominated by the cough attribute in the symptoms complexes; 48.4% of patients with severe asthma and 31.3% with moderate asthma consistently chose the alternative with the lowest level of cough. Furthermore, cough predominance was found to be significantly associated with severity of asthma (p=0.047). Patients with moderate asthma were not willing to accept any additional symptoms to reduce cough from severe to mild. However, these patients were willing to accept mild breathlessness, mild sleep disturbance, severe chest tightness and severe wheezing to remove coughing altogether. Patients with asthma prefer to have less cough and are willing to accept greater levels of other symptoms to achieve this. Additionally, asthma severity may influence an individual's perception of their symptoms; cough is a more important symptom for patients with severe asthma than those with a milder disease.

Development and Utilization of a Diagnostic Support Tool for Asthma within the Electronic Medical Record.

Asthma in childhood is a common and costly chronic disease. Quality asthma care can lead to better control of asthma thus decreasing use of health services. The gold standard for pediatric asthma diagnosis and management is the National Heart, Lung and Blood Institute (NHLBI) guidelines for Diagnosis and Management of Asthma which center on precisely establishing the severity of asthma, as this precise classification delineates appropriate therapy. However, navigating these guidelines is a challenge for primary care providers that creates a barrier to providing quality care. We aim to improve precision in asthma severity classification in the community healthcare setting through the development of an electronic asthma decision support tool (eADST) incorporating NHLBI guidelines embedded within the electronic health record system. We developed an algorithm for the eADST to guide the health care provider to the appropriate classification and subsequent therapy. We engaged our health system's electronic health record informatics team and together developed and revised the tool. We launched the tool in three academic community clinics and measured precision in asthma classification in the twelve months prior to the availability of the tool and the twelve months following the launch. We found a significant improvement in precision of asthma severity classification following the launch, a necessary first step in improvement of asthma care. The next step will be to evaluate the impact of the tool on asthma outcomes.

The relationship of eosinophil cationic protein / eosinophil count ratio and disease severity in allergic asthma patients

Finding an applicable clinical biomarker in body fluids can be useful in asthma management. This study was conducted to support the investigations of probable immunological changes in asthmatic patients that may be useful therapeutic indicators. 61 matching patients and 23 apparently healthy individuals were included. Significant elevation in the level of eosinophil cationic protein (ECP) in asthmatics was found as compared with healthy controls, so as among asthma severity categories. The receiver operating characteristic curve analysis determined 29 ng/ml of serum ECP as the typical cut-off value of significant denotation for differentiation between asthmatic patients and healthy individuals, significant positive linear correlation between both ECP level and also ECP/Eosinophil ratio with clinically estimated asthma severity were observed. The median of serum total IgE and rate of 100 IU/ml overlapped serum total IgE individuals were significantly higher in asthmatics than healthy controls and so as among asthma severity categories, whereas no significant correlation between total serum IgE level and asthma severity was found. According to the results, determination of serum ECP can be considered as a diagnostic tool to distinguish asthma cases, besides it reflects the severity of the disease significantly, whereas calculation of ECP/Eo ratio may be an effective marker in reflecting asthma severity and the activity of eosinophils during the inflammation which may be useful in asthma control and in the assessment of the disease severity as well as the response to anti-inflammatory therapy, but it has no benefit for diagnosing asthma as no significant differences were recorded between asthmatics and healthy controls.

Assessment of airway remodeling by quantitative computed tomography at various degrees of asthma severity defined according to the Global Initiative for Asthma report: a single-center study.

In asthma, airway remodeling is defined as structural changes of the airways. The association between remodeling and asthma severity is still unclear, and there are limited data on the intensity of airway remodeling in various stages of the disease as defined in the Global Initiative for Asthma (GINA) asthma severity classification. Computed tomography (CT) and postprocessing applications are effective tools to assess the intensity of airway remodeling. The aim of this study was to assess the severity of morphometric abnormalities of the respiratory tract in patients with various degrees of asthma severity according to the GINA guidelines. The study included 70 patients with asthma and 29 healthy controls matched for age, sex, and body mass index. Patients were examined with a 128 multislice CT scanner at full inspiration. The measurements were made from the third to the ninth generations of bronchi. Bronchial parameters were compared between patients with severe and nonsevere asthma and healthy controls. We found no differences in the thickness of the bronchial wall, percentage of the wall area, inner and outer bronchial diameters, and the size of the bronchial lumen between severe and nonsevere asthma groups. Significant differences were noted in the thickness of the bronchial wall and the percentage of the wall area between the severe asthma group and the control group (P <0.017) as well as between the nonsevere asthma group and controls (P <0.017). Our findings indicated similar values of CT morphological measures of airway remodeling in all asthma severity groups as defined by the GINA guidelines.

Clustering of asthma and related comorbidities and their association with maternal health during pregnancy: evidence from an Australian birth cohort

BackgroundThe population-based classification of asthma severity is varied and needs further classification. This study identified clusters of asthma and related comorbidities of Australian children aged 12–13 years; determined health outcome differences among clusters; and investigated the associations between maternal asthma and other health conditions during pregnancy and the children’s clustered groups.MethodsParticipants were 1777 children in the birth cohort of the Longitudinal Study of Australian Children (LSAC) who participated in the Health CheckPoint survey and the LSAC 7th Wave. A latent class analysis (LCA) was conducted to identify clusters of children afflicted with eight diseases, such as asthma (ever diagnosed or current), wheezing, eczema, sleep problem/snoring/breathing problem, general health status, having any health condition and food allergy. Multinomial logistic regression was used to investigate the association between maternal asthma or other health conditions and LCA clusters.ResultsThe study identified four clusters: (i) had asthma – currently healthy (11.0%), (ii) never asthmatic & healthy (64.9%), (iii) early-onset asthmatic or allergic (10.7%), and (iv) asthmatic unhealthy (13.4%). The asthmatic unhealthy cluster was in poor health in terms of health-related quality of life, general wellbeing and lung functions compared to other clusters. Children whose mothers had asthma during pregnancy were 3.31 times (OR 3.31, 95% CI: 2.06–5.30) more likely to be in the asthmatic unhealthy cluster than children whose mothers were non-asthmatic during pregnancy.ConclusionUsing LCA analysis, this study improved a classification strategy for children with asthma and related morbidities to identify the most vulnerable groups within a population-based sample.

The Effect of Oral Magnesium Sulfate on Moderate and Severe Asthma Exacerbation in Children Referred to Pediatrics Emergency Department: The Moderating Role of Asthma Severity

Background: Asthma is the most common chronic disease in childhood and cause of hospitalization.Intravenous magnesium sulfate is recommended as a complementary therapy for asthma exacerbation.This study investigate the effect of oral magnesium sulfate on moderate and severe asthma exacerbation in children. Methods: This double-blind clinical trial was performed on 40children 5-12 years old with asthma exacerbation who referred to Pediatric Emergency Department of Quaem Hospital in Mashhad, Iran. Patients were randomly assigned into two groups , received magnesium sulfate (300 mg every 12 hours) or placebo capsules for 5 days. Asthma severity score based on Siriraj clinical asthma score (SCAS) contained in the questionnaire was recorded for each patient at 0, 2, 6, and 24 hours after first visit, and then daily up to 5 days. The patients were divided into three groups by researcher: A(Mild) :0-8, B(Modrate):8-16, C(Severe):16-24. Results: The mean age of subjects was 8.20 ± 2.49 age and mean weight was 26.32 ± 8.65 kg. Classification of asthma severity in the magnesium group included 5 patients in A, 14 in B and 1 in C and in placebo group 8 in A,8 in B and 4 in C .The present study, controlling the effect of weight as a covariate, didn't indicate a significant effect of oral magnesium sulfate on asthma symptoms in 5-12 years old children (P=0.15); however, after considering the severity variable as moderator, indicated a minor effect on symptom improvements in B score. Conclusion: Adminstration of oral magnesium sulfate Within 5 days, didn't improve asthma exacerbation in5-12 years old children.So, more studies with different dose and duration are needed to determine efficacy of oral mgso4 in asthma exacerbation.

National Asthma Education and Prevention Program 2020 Guidelines: What's Important for Primary Care.

• The 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group provides updated recommendations for 6 topics related to the management of individuals with asthma. • The classification of asthma severity and asthma control, as well as the concept of utilizing a stepwise approach to pharmacologic treatment, were not updated from the Expert Panel Report 3, released in 2007. • However, important updates in preferred therapies for intermittent and persistent asthma at treatment steps 1 through 5 were suggested. • Recommendations regarding biologic therapy were not included in the 2020 update, as only evidence and US Food and Drug Administration approvals through October 2018 were considered. • The most recent 2021 Global Initiative for Asthma guidelines are not included in this review but can be used in a complementary manner to assist primary care clinicians to optimize decisions regarding the care of patients with asthma.

Pediatric respiratory assessment measure in evaluation of the severity of bronchial asthma exacerbation in children

Objective The aim was to study the role of pediatric respiratory assessment measure (PRAM) score in evaluation of acute asthma exacerbation in children. Background Acute severe asthma is one of the most common medical emergency situations in childhood, where accurate assessment and management is of extreme importance and may be lifesaving. PRAM score has been used to classify asthma severity and treatment. Patients and methods A prospective cohort study was adopted by applying the PRAM score on 108 asthmatic children presented to the Emergency Department of Elraml Pediatric Hospital in Alexandria by acute asthma exacerbation in the period of the study. Results The study included 66 (61.1%) boys and 42 (38.9%) girls, aged from 2 to 12 years, with mean age of 5.07 ± 2.68 years. The most common triggering factor according to our study was viral infection or common cold (90.7%). Increasing severity of acute asthma exacerbation was associated with increasing initial PRAM score. There was significantly increased severity of grade of PRAM score after initial bronchodilator therapy in relation to young aged children ( Conclusion PRAM score in this study is useful for predicting fate of patients in emergency room, and after initial bronchodilator therapy, it is an excellent sensitive and specific tool to predict the admitted patients from the discharged patients.

Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk.

BackgroundChlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported.MethodsThe author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented.FindingsNo large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity.InterpretationC. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.

Are the Global Initiative for Asthma (GINA) Guidelines Being Correctly Used to Diagnose Severe Asthma in the UAE?

ObjectivesWe aimed to identify the percentage inaccuracy in classifying asthma severity as severe asthma based on the 2019 Global Initiative for Asthma (GINA) guidelines criteria, at Cleveland Clinic Abu Dhabi, and make recommendations to improve the assessment of asthma severity.MethodsAll asthma patients that attended the Pulmonology clinic or the Allergy clinic from May 2015 to December 2019 were retrospectively analyzed to identify which asthma patients classified as having severe asthma according to the 2019 GINA guidelines criteria. We then calculated the percentage inaccuracy associated with giving diagnoses of severe asthma.ResultsWe retrospectively analyzed a total of 902 patients, and out of those, we identified 334 as patients with severe asthma according to the 2019 GINA guidelines criteria. Of those 334 patients, 218 were given an incorrect asthma severity of either mild (N=14), moderate (N=203), or unspecified asthma severity (N=1) in the hospital’s electronic records. This represents a percentage inaccuracy of 65.3% in classifying asthma severity as severe asthma. Fluticasone propionate-salmeterol was the most used ICS-LABA (inhaled corticosteroid and long-acting beta-agonist) medication in the severe asthma group (58.1%). Fluticasone furoate-vilanterol was identified as the most incorrectly prescribed ICS-LABA medication (68.2%).ConclusionWe identified an inaccuracy of 65.3% in classifying asthma severity as severe at our hospital. This inaccuracy is associated with a lack of understanding of the GINA guidelines by clinicians, as well as a lack of acceptance of some of the criteria in the GINA guidelines by patients. We have made recommendations to help improve the accuracy of asthma severity assessment, in order to be fully adherent to the GINA guidelines criteria.

The Impact of Adenotonsillectomy on Pediatric Asthma

To prospectively evaluate the effects of adenotonsillectomy (T&A) for sleep disordered breathing (SDB) on asthma outcomes as compared with control asthmatics who did not have a T&A.Children aged 4 to 11 years with asthma who underwent T&A for SDB (n = 80) were included. Control patients with asthma (n = 62) were recruited from clinical office visits and did not have clinical SDB and/or polysomnography as indications for T&A. Control patients were matched to the study patients on the basis of age within 1 year, sex, and Asthma Severity Classification. SDB was based on overnight polysomnography and/or clinical assessment of nighttime symptoms of snoring and breathing difficulties, daytime symptoms, physical examination findings, and the Clinical Assessment Score-15, a tool for diagnosing SDB. Asthma was diagnosed and managed by a pediatric pulmonology specialist or a pediatrician on the basis of clinical history, pertinent family history, response to medications, pulmonary function tests, and the exclusion of other diagnoses.Asthma Severity Classification was determined by chart review and was classified on the basis of the National Heart, Lung, and Blood Institute guidelines. Asthma clinical outcomes, including the number of asthma exacerbations, frequency of systemic steroid use, number of emergency department visits for asthma, and number of hospitalizations for asthma in the previous 6 months were assessed. Childhood Asthma Control Test (C-ACT), the primary outcome measure, and Pediatric Sleep Questionnaire (PSQ) scores were obtained at study entry and at 6 months after surgery or enrollment.Subjects had a mean age of 6.8 years, at least 60% were boys, the majority were black, and most had intermittent or mild persistent asthma. T&A subjects were more likely obese (45% vs 34%). Asthma exacerbations and emergency department visits were improved for both groups, steroid use was improved in only the T&A group, and hospitalizations were improved only in the controls. However, the frequency of all these events at entry and follow-up were low for both groups. Mean C-ACT scores were similar at entry (T&A = 21.86, control = 22.42) but significantly different at follow-up (T&A = 25.15, control = 23.59) and overall significantly improved for both groups at follow-up. Mean PSQ scores significantly improved (T&A = 0.14, control = 0.17) for both groups at 6 months. Baseline PSQ and study group assignment were the main predictors of change in the C-ACT.Treatment of SDB significantly improved C-ACT and PSQ scores. Asthma clinical outcomes were slightly improved but were already not occurring often at baseline.Although ethical constraints preclude comparing T&A versus no T&A in children with SDB, this supports other studies that show that T&A improves asthma. Interestingly, the controls also had improvement in their mean C-ACT and PSQ scores without any intervention. Limitations include that the sample size was not large enough to assess how T&A really would have affected asthma clinical outcomes and that most of the subjects had intermittent or mild persistent asthma at baseline, so it is unknown how these findings would apply to patients with moderate or severe asthma.

Identification of asthma severity levels through wheeze sound characterization and classification using integrated power features

ObjectiveThis study aimed to investigate and classify wheeze sound characteristics according to asthma severity levels (mild, moderate and severe) using integrated power (IP) features. MethodValidated and segmented wheeze sounds were obtained from the lower lung base (LLB) and trachea recordings of 55 asthmatic patients with different severity levels during tidal breathing manoeuvres. From the segments, nine datasets were obtained based on the auscultation location, breath phases and their combination. In this study, IP features were extracted for assessing asthma severity. Subsequently, univariate and multivariate (MANOVA) statistical analyses were separately implemented to analyse behaviour of wheeze sounds according to severity levels. Furthermore, the ensemble (ENS), k-nearest- neighbour (KNN) and support vector machine (SVM) classifiers were applied to classify the asthma severity levels. Results and conclusionThe univariate results of this study indicated that the majority of features significantly discriminated (p < 0.05) the severity levels in all the datasets. The MANOVA results yielded significantly (p < 0.05) large effect size in all datasets (including LLB-related) and almost all post hoc results were significant (p < 0.05). A comparison of the performance of classifiers revealed that eight of the nine datasets showed improved performance with the ENS classifier. The Trachea inspiratory (T-Inspir) dataset produced the highest performance. The overall best positive predictive rate (PPR) for the mild, moderate and severe severity levels were 100% (KNN), 92% (SVM) and 94% (ENS) respectively. Analysis related to auscultation locations revealed that tracheal wheeze sounds are more specific and sensitive predictors of asthma severity. Additionally, phase related investigations indicated that expiratory and inspiratory wheeze sounds are equally informative for the classification of asthma severity.

Predicting Lung Healthiness Risk Scores to Identify Probability of an Asthma Attack

For asthma, monitoring of symptoms and progression of the disease while avoiding triggers and minimizing the frequency of attacks are the main objectives of care. Tracking and analyzing lung healthiness, symptoms, medications, level of interference with daily life activities provides a hint of the level of severity of asthma, and that is indeed a strong predictor of subsequent and future exacerbations. In a prior effort, we employed Text Classification method to classify asthma severity. However, asthma attack prediction depends on many other risk factors such as physiological measurements, patient behaviors and characteristics, environmental triggers, and personal risk scores. In this paper, we propose a method to forecast future asthma attacks using historical data linking the asthma severity level and the personalized risk scores of triggers. Specifically, we used the Additive Interaction Analysis of Exposures technique combined with the Long Short-Term Memory method to predict risk scores of respiratory and oxygen saturation. These risk scores are then used to forecast the probability of an asthma attack.

The impact of adenotonsillectomy on pediatric asthma.

To determine asthma outcomes in children undergoing adenotonsillectomy (T&A) for treatment of sleep-disordered breathing (SDB). Asthmatic children will demonstrate improvement in asthma control after T&A compared to asthmatic children not undergoing surgical treatment. Prospective cohort. 80 children with diagnosed asthma, aged 4-11, undergoing T&A and 62 controls matched to the T&A subjects by age, sex, and asthma severity classification. Parents and children completed the Childhood Asthma Control Test (C-ACT) and the Pediatric Sleep Questionnaire (PSQ). Parents were queried regarding the number of asthma exacerbations, the frequency of the use of systemic steroids, the number of emergency room visits and the number of hospitalizations in the prior 6 months. The identical questionnaires and interviews were completed 6 months after entry. The adjusted mean (95% CI) C-ACT score was 21.86 (20.94-22.68) at entry and 25.15 (24.55-25.71) at follow-up for the T&A group compared with 22.42 (21.46-23.28) and 23.59 (22.77-24.33) for the control group. There was a significant group by time interaction (P < 0.001). Simple effects analysis showed that group means did not differ at entry (P = 1.00) but did differ at follow-up (P = 0.006). Baseline PSQ was a significant predictor of improvement in C-ACT scores. Statistical modeling did not demonstrate significant group by time interactions for any of the asthma clinical outcomes, although these outcomes were very infrequent in both groups. Treatment of SDB improves asthma outcomes as measured by the C-ACT.

Visual analogue scale for sino-nasal symptoms severity correlates with sino-nasal outcome test 22: paving the way for a simple outcome tool of CRS burden

BackgroundA visual analogue scale (VAS) is a psychometric instrument widely used in the Rhinology field to subjectively quantify patient’s symptoms severity. In allergic rhinitis, VAS has been found to correlate well with the allergic rhinitis and its impact on asthma severity classification, as well as with rhinoconjunctivitis quality of life questionnaire. In chronic rhinosinusitis (CRS), total VAS score are often used to classify disease burden into mild, moderate, and severe, with few studies correlating VAS scores with more complex and validated instruments assessing disease-specific burden like Sino-Nasal Outcome Test (SNOT)-22.MethodsWe correlated VAS scores for total and individual sino-nasal symptom with SNOT-22 scores in a randomly selected group of 180 CRS patients. Pearson’s rho was selected as a correlation coefficient for analysis.ResultsVAS scores for total nasal symptom score and individual symptoms correlated significantly with SNOT-22, irrespective of VAS based subclasses for sino-nasal, ocular, and bronchial symptoms.ConclusionsVAS for total sino-nasal symptom severity might be used for assessing disease severity, monitoring the course of the disease, and can be used for treatment decisions and disease burden.

Using medication utilization information to develop an asthma severity classification model

BackgroundClaims data are currently widely used as source data in asthma studies. However, the insufficient information in claims data related to level of asthma severity may negatively impact study findings. The present study develops and validates an asthma severity classification model that uses medication utilization in Taiwan National Health Insurance claims data.MethodsThe National Health Insurance Research Database was used for the years 2006–2012 and included a total of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation. The medication utilization of patients during the first year after the index date was used to classify level of severity, and the acute exacerbation of asthma during the second through fourth years after the index date was used as the outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively. The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to compare the performances of the classification models.ResultsIn development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4 were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment. Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication uses among stages were similar to those in development data, and the results of survival analysis were also the same.ConclusionsUnderstanding asthma severity is critical to conducting effective, scholarly research on asthma, which currently uses claims data as a primary data source. The model developed in the present study not only overcomes a gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based asthma studies.

Assessment of asthma severity in adults with ever asthma: A continuous score.

BackgroundIn epidemiological studies, continuous measures of asthma severity should be used to catch the heterogeneity of phenotypes. This study aimed at developing and validating continuous measures of asthma severity in adult patients with ever asthma from the general population, to be used in epidemiological studies.MethodsRespiratory symptoms, anti-asthmatic treatment and lung function were measured on 520 patients with ever asthma aged 20–64 years from the general Italian population (GEIRD study; 2007/2010). The variables that represent the same dimension of asthma severity were identified through an exploratory factor analysis and were summarized through a multiple factor analysis.ResultsOnly respiratory symptoms and anti-asthmatic treatment were summarized in a continuous score (STS). STS ranges from 0 (no symptoms/treatment) to 10 (maximum symptom frequency and treatment intensity). STS was positively correlated with the Global Initiative for Asthma classification of asthma severity computed on the 137 cases with a doctor's diagnosis (Spearman’s coefficient = 0.61, p-value<0.0001) (concurrent validity). Furthermore, using a cohort of 1,097 European asthmatics (ECRHS II study; 1999/2002), increasing STS levels at baseline (1991/1993) were positively associated with long-term outcomes (hospitalization and lost workdays for breathing problems, asthma attack frequency and use of asthma controllers) (predictive validity). Finally, the STS scores computed from the GEIRD and ECRHS II data were comparable (Lin’s coefficient = 0.95, p-value<0.0001) (replication analysis).ConclusionsSTS is a valid and replicable measure of asthma severity in adults, which could be used in association studies.