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Score helps build asthma risk registers

GPs can now use a newly validated risk tool to help predict which of their asthma patients are likely to be admitted to hospital, writes Daniel Cressey.

Patients scoring highly on the TENOR risk tool were 12 times more likely to attend hospital than low scorers, according to a new study.

The score, based on US data, found a number of factors predicted high risk of admission, including younger age, female sex, BMI, FVC less than 70 per cent predicted, pneumonia history, diabetes and cataracts.

Experts said the score could help GPs draw up at-risk registers for asthma patients, but first needed to be adapted for UK populations.

Study author Professor Scott Weiss, professor of medicine at Harvard Medical School in Mas-sachusetts, US, said: 'The ability to predict clinical events is critical. The score is ideally suited for adult patients with sev-

ere or difficult-to-treat asthma.'

Dr Kevin Gruffydd-Jones, committee member of the General Practice Airways Group and a GP in Box, Wiltshire, said: 'It would be very good to have a simple index we could use to identify those patients we need to concentrate on.'

Patients are scored out of a possible 18 on a number of

factors.

In the new study those scoring five to seven points were found to have a 3.5-fold increased risk of a hospitalisation or A&E visit, compared with those scoring four or less. A score of eight or more indicated a 12-fold higher risk.

In total there were 239 hospitalisations or A&E visits, 119 occurring in the 455 patients in the cohort scoring eight or above, the research team reported in the latest issue of the European Respiratory Journal.

• For guidelines and evidence-based medicine – go to searchmedica.co.uk

Predicting asthma risk

SLIDING SCALE

Age yrs

• 0: =60

• 1: 50-59

• 2: 35-49

• 3: 18-34

Steroid bursts in last three months

• 0: 0 steroid bursts

• 1: 1 steroid burst

• 2: 2 steroid bursts

• 3: 3 or more steroid bursts

One point for each of the following:

• Female sex

• BMI =35

• History of pneumonia

• Current diabetes

• Current cataracts

• Nebuliser ipratropium bromide

• Use of steroids at least every other day

• Ever intubated

Two points for each of the following:

• Non-white ethnicity

• FVC <70 per="" cent="">

OUTCOME

Total possible score 18

Low risk = 0-4/moderate

risk = 5-7/high risk =8

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