Short- and long-term asthma exacerbation risk predicted by AIRQ® score in patients with very poorly controlled disease

24 Mar 2023

In general, there is a lack of an easy method for assessing asthma management, in terms of considering the risk of exacerbation and symptom impairment, as well as accounting for how asthma affects the daily life of patients.1 To address this issue, a simple 10-item yes/no tool named the Asthma Impairment and Risk Questionnaire (AIRQ®) was developed to assess symptom worsening and exacerbation risk.2 The AIRQ® categorized asthma control as well controlled (WC), not well controlled (NWC), and very poorly controlled (VPC).2 These control levels at baseline could predict one-year future disease exacerbation, and as compared with WC, both NWC and VPC patients had a 2X and 4.6X greater chance of experiencing an exacerbation, respectively.2 A new study explored the capability of the AIRQ® score in predicting exacerbations in a shorter period.2 The results were presented at the Annual Meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI) in February 2023.2

This study evaluated if the AIRQ® tool was capable of correctly predicting the short-term (0-3 months) and long-term (4-12 months) asthma exacerbation risk.2 The study included patients aged ≥12 years with a confirmed diagnosis of asthma from 24 different allergy and pulmonary care locations.2 Patients with a diagnosis of any other chronic lower respiratory conditions, prior bronchial thermoplasty, and ≥3 months of continuous oral corticosteroid use ≥10mg/day at entry were excluded.2 Patients were monitored using an online survey each month for a year.2 The definition of a patient-reported asthma exacerbation was a change in the asthma clinical status requiring a course of systemic corticosteroids (oral steroids for 3 days), an unanticipated visit to the emergency room, urgent care, or office, or a hospital stay for asthma lasting for >24 hours.2

Through the 12-month research period, 1,070 patients completed ≥1 survey, with a mean of 10.5 [standard deviation (SD)=2.8] monthly follow-up surveys completed, and the majority (n=817; 76.4%) completed ≥11 months of follow-up.2 According to the baseline AIRQ®, 35.2% of patients were categorized as WC, 38.1% as NWC, and 26.6% as VPC.2

Over the first 3 months, 277 patients (26.7%) had ≥1 exacerbation; 13.8% were WC, 26.0% NWC, and 45.4% VPC.2 NWC and VPC scores statistically significantly predicted patient-reported exacerbations as compared with the WC group (NWC vs. WC: OR=2.17; 95% CI: 1.49, 3.15; VPC vs. WC: OR=4.51; 95% CI: 3.05, 6.67); while age, gender, race, and body mass index (BMI) were not significant predictors.2 During months 4-12, 376 patients (36.2%) had ≥1 exacerbation; 20.7% were WC, 38.4% were NWC, and 53.4% were VPC.2 Of note, both NWC and VPC were significant predictors of exacerbations compared with WC (NWC vs. WC: OR=2.37; 95% CI: 1.70, 3.30; VPC vs. WC: OR=3.83; 95% CI: 2.67, 5.48); whereas demographic factors were not significant.2 There was no significant difference in exacerbation prediction performance between the 2 time frames.2

In conclusion, the AIRQ® tool can predict future asthma exacerbation risk in the short- (0-3 months) and long-term (4-12 months) periods.2 In both periods, patients with the NWC and VPC control levels as measured by AIRQ® had higher exacerbation rates.2 These findings on the prediction of short-term exacerbations highlighted the necessity of routine monitoring of asthma control with a follow-up AIRQ® between yearly visits.2

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