PURPOSE:American Thoracic Society (ATS) asthma impairment rating scheme1 takes into account amongst other things, minimum medication needed. The medication Omalizumab is not taken into account though it may have a beneficial effect on asthma impairment with decrease in severity in the present rating scheme. This study evaluates the difference in the rating scheme if Omalizumab was included in the minimum medication rating scheme.
METHODS:ATS impairment rating scheme for asthma was applied and scores calculated at baseline and after treatment with Omalizumab (n=11). The scores were recalculated placing Omalizumab at a score of 4 or a score of 1 on the minimum medication needed scale. Paired t-Test was used to analyze the data.
RESULTS:At baseline ATS impairment scores were 6.82 scores changed to 5.18 after treatment with Omalizumab. When Omalizumab was given a score of 1 on the impairment scheme, with a significant difference of 1.64 and p=0.02. With Omalizumab given a score of 4 the recalculated impairment scores were 6.64 with no significant difference from baseline despite clinical improvement in patients. The difference was 0.18 with a p=0.76.
CONCLUSION:The present ATS rating scheme for asthma impairment may under or overestimate impairment, as it does not take into account newer medications for asthma such as Omalizumab and leukotriene inhibitors. Given a good safety profile placing medications such as Omalizumab low on the minimum medication scoring scheme may better reflect asthma impairment.
CLINICAL IMPLICATIONS:The ATS rating scheme for asthma impairment does not completely reflect changes in treatment for asthma that may have a beneficial effect on asthma severity and disabilities. The American College of Chest Physicians may need to take the lead in revamping the asthma impairment rating scheme to better reflect newer treatment modalities in the minimum medication section. Reference: 1American Thoracic Society: Guidelines for the Evaluation of Impairment/Disability in Patients with Asthma. Am Rev Respir Dis, Vol 147:1056–1061, 1993.
DISCLOSURE:Mary Zaremba, No Financial Disclosure Information; No Product/Research Disclosure Information