A multi-institute collaboration of 26 researchers led by the Mayo Clinic has developed a new asthma burden score that predicts disease severity and remission more accurately than current guidelines.

Asthma presents a significant health and economic challenge globally, with severity ranging from mild to severe cases. Current definitions primarily rely on treatment-based definitions and often fail to account for factors like asthma control and exacerbation frequency.

In the study, "Development of an asthma health-care burden score as a measure of severity and predictor of remission in SARP III and U-BIOPRED," published in The Lancet Respiratory Medicine, the team calculated a composite burden score based on asthma exacerbations, healthcare utilisation, and the use of short-acting beta-agonists and compared their scoring system to data from two major longitudinal asthma cohorts.

Data was sourced from the U.S.'s Severe Asthma Research Program III (SARP III) and the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) across 11 European countries.

In SARP III, 528 adult participants with asthma were followed for an average of 4.4 years, with 59% classified as having severe asthma. In U-BIOPRED, 509 adult participants were followed for one year, and 83% had severe asthma.

The study found discrepancies between current definitions of asthma severity and actual patient outcomes. Of the 528 SARP III participants, 59% had severe asthma, according to ERS-ATS definitions. Of these individuals, 34% had a burden score below 1.29 per patient year, indicating a relatively low disease burden. Similarly, 27% of U-BIOPRED participants with non-severe asthma had high burden scores.

In both cohorts, higher burden scores correlated with reduced lung function, poorer asthma control, and lower quality of life. Traditional biomarkers like blood eosinophil counts and fractional exhaled nitric oxide did not correlate with the burden score, whereas higher blood neutrophil counts were associated with higher scores.

Results of the study suggest that the asthma burden score offers a more precise, patient-centred tool for assessing asthma severity and predicting remission.

By incorporating real-world data on healthcare utilisation and symptom control, the new scoring system challenges the value of treatment-based severity scores. The findings suggest that pending further validation, this burden score could optimise management strategies, particularly for high-risk individuals, by providing a more personalised assessment of disease severity.