Asthma and lower airway diseaseDevelopment and validation of the Composite Asthma Severity Index—an outcome measure for use in children and adolescents
Section snippets
Overview
There were 4 distinct steps in the development of CASI (Fig 1). First, the independent outcome domains of asthma were determined via factor analysis by using data from more than 500 children and adolescents in the Asthma Control Evaluation (ACE) trial. Second, 26 asthma experts made individual and group decisions as to how the components of these domains should be weighted and combined into a final CASI score. Third, the scale properties of CASI were evaluated. Finally, CASI was externally
Determining independent dimensions of asthma severity
The factor analysis revealed 5 independent domains of asthma among the 11 commonly employed asthma outcomes. Those domains were as follows: symptoms (combining days and nights of symptoms and days and nights of albuterol usage), controller medication usage (inhaled corticosteroids prescribed and long-acting β-agonists prescribed), lung function (FEV1 percent predicted and ratio of FEV1 to forced vital capacity), oral corticosteroid bursts, and unscheduled visits (including emergency department
Discussion
Unlike many instruments that measure only asthma control, CASI quantifies asthma severity by using multiple dimensions. By incorporating symptoms, exacerbations, lung function, and treatment requirements into a single index, CASI combines domains of impairment and future risk with the level of treatment needed to reach the current clinical state, and in doing so, addresses the need for a comprehensive asthma index that reflects disease severity. This measure of asthma severity provides a means
References (22)
- et al.
Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial
Lancet
(2008) - et al.
Factors associated with asthma exacerbations during a long-term clinical trial of controller medications in children
J Allergy Clin Immunol
(2008) - et al.
FEV1 is associated with risk of asthma attacks in a pediatric population
J Allergy Clin Immunol
(2001) - et al.
Recent asthma exacerbations: a key predictor of future exacerbations
Respir Med
(2007) - et al.
Common measures of asthma severity lack association for describing its clinical course
J Allergy Clin Immunol
(1994) - et al.
A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study
J Pediatr
(1999) - et al.
Achieving and maintaining asthma control in an urban pediatric disease management program: the Breathmobile Program
J Allergy Clin Immunol
(2007) - National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management...
- et al.
Consensus methods: characteristics and guidelines for use
Am J Public Health
(1984) - et al.
A randomized trial of omalizumab (anti-IgE) for asthma in inner-city children
N Engl J Med
(2011)
An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations. Standardizing endpoints for clinical asthma trials and clinical practice
Am J Respir Crit Care Med
Cited by (0)
This project was funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract nos. NO1-AI-25496 and NO1-JAI-25482. Additional funds were provided by the National Center for Research Resources, National Institutes of Health, under grants RR00052, M01RR00533, 1UL1RR025771, M01RR00071, 1UL1RR024156, 5UL1RR024992-02, and 5M01RR020359-04.
Disclosure of potential conflict of interest: M. Kattan and G. R. Bloomberg have received research support from the National Institute of Allergy and Infectious Diseases (NIAID)/National Institutes of Health (NIH). S. J. Szefer has consulted for GlaxoSmithKline, Genentech, Merck, Boehringer-Ingelheim, Novartis, and Schering-Plough and has received research support from GlaxoSmithKline, the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Environmental Health Sciences (NIEHS), the NIAID, the NIH, and the Environmental Protection Agency. R. A. Wood has consulted for the Asthma and Allergy Foundation of America, received research support from the NIH, and served on the medical advisory board for the Food Allergy and Anaphylaxis Network. A. H. Liu has received a speaker honorarium from Merck. J. A. Pongracic has received research support from the NIAID. J.F. Chmiel has received research support from the NIH. W. J. Morgan has consulted for the Cystic Fibrosis Foundation, Genentech, and Novartis and has received research support from the NIH and Novartis. W. W. Busse has served on advisory boards for Centocor and Merck; has consulted for Amgen, AstraZeneca, Novartis, GlaxoSmithKline, MedImmune, and Genentech; and has received research support from the NIAID/NHLBI/NIH. The rest of the authors declare that they have no relevant conflicts of interest.