Development and validation of personalised prediction to estimate future risk of severe exacerbations and uncontrolled asthma in patients with asthma, using clinical parameters and early treatment response

Publication date: Available online 21 June 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Suzanne Boer, Jacob K. Sont, Rik JB. Loijmans, Jiska B. Snoeck-Stroband, Gerben ter Riet, Tjard RJ. Schermer, Willem JJ. Assendelft, Persijn J. Honkoop
BackgroundCurrent level of asthma control can be easily assessed by validated instruments, but it's currently difficult to assess individuals' level of future risk.ObjectiveDevelop, and validate, a risk prediction score for level of future risk, including patient characteristics and information on early treatment response.MethodsWe used data of 304 adult asthmatics from a 12-month primary care RCT with three-monthly assessments. With logistic regression we modelled the association between level of future risk and patient characteristics including early treatment response. Future risk was defined as ACQ ≥ 1.5 at 12 months or the experience of at least one exacerbation during the final six months. We developed a risk prediction score based on the regression coefficients.ResultsPerformance of the risk prediction score improved taking into account data on early treatment response (AUROC 0.84) compared to a model containing only baseline characteristics (AUROC = 0.78). The score includes six easy to obtain predictors; sex, ACQ-score and exacerbations in the previous year at baseline and at 1st follow-up ACQ, smoking status and exacerbations in the previous three months (indicating early treatment response). External validation yielded an AUROC of 0.77. The risk prediction score classified patients into three risk groups, low (absolute risk 11.7%),  intermediate (47.0%) and high level of risk (72.7%).ConclusionWe developed and externally validated a risk prediction score, quantifying both level of current asthma control and the guideline-defined future risk. Patients' individual risk can now be estimated in an easy way, as proposed but not specified, by asthma management guidelines.