Asthma questionnaire productive at assessing short-, long-term exacerbation risk

SAN ANTONIO — An asthma risk questionnaire was effective in predicting exacerbations for patients over both short and long terms, data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting showed.

William McCann, MD, FAAAAI, vice president and chief medical officer of Allergy Partners, told Healio that initial results from the Asthma Impairment and Risk Questionnaire, or AIRQ, showed that the tool was very strong at indicating risk levels for future exacerbations over the next year.

“So, patients who were more poorly controlled were more prone to have exacerbations in the next year,” he said. “The question that came up [was], ‘It will predict exacerbations in the next year, but what about in the next couple months?’”

The AIRQ — a yes or no, 10-item resource — determined levels of patient control depending on total yes responses, with:

• yes responses of 0 or 1 indicating well controlled (WC);
• yes responses of 2 to 4 indicting not well controlled (NWC); and
• yes responses of 5 to 10 indicating very poorly controlled (VPC).

To assess control levels’ associations with future risk, the researchers issued a baseline AIRQ and monthly reports on exacerbations for 12 months. A total of 1,070 patients (mean age, 43 years; 70.5% women) aged 12 years and older completed one or more surveys.

At baseline, 35.2% that were WC, 38.1% of patients were NWC and 26.6% that were VPC. Between 0 to 3 months, 277 patients experienced at least one exacerbation, while 376 patients experienced an exacerbation from 4 to 12 months.

The researchers found that overall, short- and long-term exacerbation rates increased with worsening AIRQ control.

From 0 to 3 months, rates among the subgroups were 13.8% for WC, 26% for NWC and 45.4% for VPC. Compared with those who were WC during this period, those NWC had an odds ratio of 2.17 (95% CI, 1.49-3.15), whereas those who were VPC saw similarly heightened odds (OR = 4.51; 95% CI, 3.05-6.67).

Meanwhile, from 4 to 12 months, those who scored as WC had an exacerbation rate of 20.7%, compared with 38.4% and 53.5% for those NWC and VPC, respectively.

“What this tells me as a clinician, if I have a patient whose AIRQ score is not well controlled or very poorly controlled, I know they’re at an increased risk for an exacerbation, and they’re at an increased risk for exacerbation in the short term as well as in the longer term,” McCann said.

To McCann, the scores represent a call to action and an opportunity for clinicians to ask what needs to be done differently in patient control.

“I think it’s a really important study that allows us to call out the power of this tool, as well as giving it teeth when you have that conversation with patients about what do we need to do today to get this under control,” he said.

Moving forward, McCann highlighted the development of a pediatric-based AIRQ.

“Right now, it’s for patients 12 [years] and up,” he said. “The same goal is to provide that very easy, at-a-glance but powerful way to assess control today and the risk of future events coming up.”