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Original Research: ASTHMA |

Risk Factors and Predictive Clinical Scores for Asthma Exacerbations in Childhood

Erick Forno, MD, MPH; Anne Fuhlbrigge, MD; Manuel E. Soto-Quirós, MD, PhD; Lydiana Avila, MD; Benjamin A. Raby, MDCM, MPH; John Brehm, MD, MPH; Jody M. Sylvia, MS; Scott T. Weiss, MD; Juan C. Celedón, MD, DrPH, FCCP
Author and Funding Information

From the Channing Laboratory (Drs Forno, Fuhlbrigge, Raby, Brehm, Weiss, and Celedón, and Ms Sylvia) and Division of Pulmonary/Critical Care Medicine (Drs Fuhlbrigge, Raby, Brehm, and Celedón), Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Respiratory Diseases (Dr Forno), Department of Pediatrics, Children’s Hospital, Boston, MA; Harvard Medical School (Drs Forno, Fuhlbrigge, Raby, Brehm, Weiss, and Celedón), Boston, MA; and Division of Pediatric Pulmonology (Drs Soto-Quirós and Avila), Hospital Nacional de Niños, San José, Costa Rica.

Correspondence to: Juan C. Celedón, MD, DrPH, FCCP, Niels K. Jerne Professor of Pediatrics and Medicine, University of Pittsburgh School of Medicine, Division Chief, Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Rangos Bldg, Rm 9130, Pittsburgh, PA 15224; e-mail: juan.celedon@chp.edu


Funding/Support: The Genetics of Asthma in Costa Rica study is supported by National Institutes of Health [Grants HL04370 and HL66289]. The Childhood Asthma Management Program is supported by National Heart, Lung, and Blood Institute [Grants NO1-HR-16044, NO1-HR-16045, NO1-HR-16046, NO1-HR-16047, NO1-HR-16048, NO1-HR-16049, NO1-HR-16050, NO1-HR-16051, and NO1-HR-16052] and General Clinical Research Center [Grants M01RR00051, M01RR0099718-24, M01RR02719-14] and the National Center for Research Resources [Grant RR00036]. This work was conducted at the Channing Laboratory of Brigham and Women’s Hospital.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1156-1165. doi:10.1378/chest.09-2426
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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.

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