Risk factors and predictive clinical scores for asthma exacerbations in childhood.
BACKGROUND
Asthma is a major public health problem that affects millions of children worldwide, and exacerbations account for most of its morbidity and costs. Primary-care providers lack efficient tools to identify children at high risk for exacerbations. We aimed to construct a clinical score to help providers to identify such children.


METHODS
Our main outcome was severe asthma exacerbation, which was defined as any hospitalization, urgent visit, or systemic steroid course for asthma in the previous year, in children. A clinical score, consisting of a checklist questionnaire made up of 17 yes-no questions regarding asthma symptoms, use of medications and health-care services, and history, was built and validated in a cross-sectional study of Costa Rican children with asthma. It was then evaluated using data from the Childhood Asthma Management Program (CAMP), a longitudinal trial cohort of North American children.


RESULTS
Compared with children at average risk for an exacerbation in the Costa Rican validation set, the odds of an exacerbation among children in the low-risk (OR, 0.2; 95% CI, 0.1-0.4) and high-risk (OR, 5.4; 95% CI, 1.5-19.2) score categories were significantly reduced and increased, respectively. In CAMP, the hazard ratios for an exacerbation after 1-year follow-up in the low-risk and high-risk groups were 0.6 (95% CI, 0.5-0.7) and 1.9 (95% CI, 1.4-2.4), respectively, with similar results at 2 years.


CONCLUSIONS
The proposed Asthma Exacerbation Clinical Score is simple to use and effective at identifying children at high and low risk for asthma exacerbations. The tool can easily be used in primary-care settings.
Forno
Erick
E
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Fuhlbrigge
Anne
A
Soto-Quirós
Manuel E
ME
Avila
Lydiana
L
Raby
Benjamin A
BA
Brehm
John
J
Sylvia
Jody M
JM
Weiss
Scott T
ST
Celedón
Juan C
JC
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D013147:Spirometry; D011795:Surveys and Questionnaires
D018927:Anti-Asthmatic Agents
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