Can we predict fall asthma exacerbations? Validation of the seasonal asthma exacerbation index

Asthma affects about 1 in 11 American children, making it one of the most common diseases of childhood.  It carries a huge burden on families, especially during exacerbations when disease activity suddenly flares, leading to breathlessness and even death.  In this month’s issue of JACI, Hoch and colleagues discuss their research in validating the Seasonal Asthma Exacerbation Predictive Index, the saEPI (J Allergy Clin Immunol 2017; 140(4): 1130-1137).  The saEPI is a score ranging from 0 to 16 that can help predict how likely a child is to have an asthma flare.  Using data from the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study, they looked at 348 children randomized to two groups: one with omalizumab, and another with guideline-based therapy alone.  They then calculated and validated the saEPI, moreover the authors looked at other factors that were associated with exacerbations.  In short, they found that children who required more aggressive treatment (high doses of inhaled corticosteroids), had higher blood eosinophils, and were younger were more likely to have a flare.  The saEPI, on the other hand, was better at determining which children were unlikely to have an asthma exacerbation.  The authors encourage providers to use data such as this to personalize their care of children at risk for asthma exacerbations. Because the children that were part of the PROSE study were largely from inner-city and minority populations and the study inclusion criteria limited some children from particpating, a similar analysis should also be performed in a more general population of children, as well as adults.  Regardless, the researchers conclude by noting the importance of such an index in managing children with asthma until even better methods are identified to classify children with asthma at risk for an asthma exacerbation.