Miller et al developed a risk score based on the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) study. This can help to identify a patient with severe or difficult-to-treat asthma who is at risk for an ED visit or hospitalization. The authors are from Genentech, Novartis, University of California, National Jewish Medical and Research Center (Denver) and Harvard Medical School.
Patient selection: adult (age 18+)
Parameters:
(1) age of the patient in years
(2) gender
(3) race
(4) body mass index (BMI) in kg per square meter
(5) lung function as percent of predicted FVC post bronchodilator
(6) previous history of pneumonia
(7) diabetes
(8) cataracts
(9) ever intubated
(10) number of steroid bursts in past 3 months
(11) ipratropium bromide nebulizer
(12) systemic corticosteroids
Parameter |
Finding |
Points |
---|---|---|
age of the patient |
>= 60 years of age |
0 |
|
50 to 59 |
1 |
|
35 to 49 |
2 |
|
18 to 34 |
3 |
gender |
male |
0 |
|
female |
1 |
race |
white |
0 |
|
not-white |
2 |
BMI |
< 35 kg per square meter |
0 |
|
>= 35 kg per square meter |
1 |
lung function |
>= 70% of predicted |
0 |
|
< 70% of predicted |
2 |
history of pneumonia |
no |
0 |
|
yes |
1 |
diabetes |
absent |
0 |
|
present |
1 |
cataracts |
absent |
0 |
|
present |
1 |
ever intubated |
no |
0 |
|
yes |
1 |
steroid bursts |
none |
0 |
|
1 |
1 |
|
2 |
2 |
|
3 or more |
3 |
nebulizer with ipratropium |
no |
0 |
|
yes |
1 |
systemic steroids |
less often than every on other day |
0 |
|
every other day or every day |
1 |
total score =
= SUM(points for all 12 items)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the greater the risk of an ED visit or hospitalization.
Total Score |
Risk |
ED or Hospital |
---|---|---|
0 to 4 |
low |
2% |
5 to 7 |
moderate |
9% |
8 to 18 |
high |
26-29% |
Purpose: To identify the risk of going to the ED or being hospitalized for an adult with severe or difficult-to-treat asthma.
Specialty: Pulmonology
Objective: risk factors, severity, prognosis, stage
ICD-10: J45,