Development and initial validation of the Asthma Severity Scoring System (ASSESS)

Anne M. Fitzpatrick, Stanley J. Szefler, David T. Mauger, Brenda R. Phillips, Loren C. Denlinger, Wendy C. Moore, Ronald L. Sorkness, Sally E. Wenzel, Peter J. Gergen, Eugene R. Bleecker, Mario Castro, Serpil C. Erzurum, John V. Fahy, Benjamin M. Gaston, Elliot Israel, Bruce D. Levy, Deborah A. Meyers, W. Gerald Teague, Leonard B. Bacharier, Ngoc P. LyWanda Phipatanakul, Kristie R. Ross, Joe Zein, Nizar N. Jarjour

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Tools for quantification of asthma severity are limited. Objective: We sought to develop a continuous measure of asthma severity, the Asthma Severity Scoring System (ASSESS), for adolescents and adults, incorporating domains of asthma control, lung function, medications, and exacerbations. Methods: Baseline and 36-month longitudinal data from participants in phase 3 of the Severe Asthma Research Program (NCT01606826) were used. Scale properties, responsiveness, and a minimally important difference were determined. External replication was performed in participants enrolled in the Severe Asthma Research Program phase 1/2. The utility of ASSESS for detecting treatment response was explored in participants undergoing corticosteroid responsiveness testing with intramuscular triamcinolone and participants receiving biologics. Results: ASSESS scores ranged from 0 to 20 (8.78 ± 3.9; greater scores reflect worse severity) and differed among 5 phenotypic groups. Measurement properties were acceptable. ASSESS was responsive to changes in quality of life with a minimally important difference of 2, with good specificity for outcomes of asthma improvement and worsening but poor sensitivity. Replication analyses yielded similar results, with a 2-point decrease (improvement) associated with improvements in quality of life. Participants with a 2-point or greater decrease (improvement) in ASSESS scores also had greater improvement in lung function and asthma control after triamcinolone, but these differences were limited to phenotypic clusters 3, 4, and 5. Participants treated with biologics also had a 2-point or greater decrease (improvement) in ASSESS scores overall. Conclusions: The ASSESS tool is an objective measure that might be useful in epidemiologic and clinical research studies for quantification of treatment response in individual patients and phenotypic groups. However, validation studies are warranted.

Original languageEnglish (US)
Pages (from-to)127-139
Number of pages13
JournalJournal of Allergy and Clinical Immunology
Volume145
Issue number1
DOIs
StatePublished - Jan 2020

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

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    Fitzpatrick, A. M., Szefler, S. J., Mauger, D. T., Phillips, B. R., Denlinger, L. C., Moore, W. C., Sorkness, R. L., Wenzel, S. E., Gergen, P. J., Bleecker, E. R., Castro, M., Erzurum, S. C., Fahy, J. V., Gaston, B. M., Israel, E., Levy, B. D., Meyers, D. A., Teague, W. G., Bacharier, L. B., ... Jarjour, N. N. (2020). Development and initial validation of the Asthma Severity Scoring System (ASSESS). Journal of Allergy and Clinical Immunology, 145(1), 127-139. https://doi.org/10.1016/j.jaci.2019.09.018