Use of the Composite Asthma Severity Index in a Pediatric Subspecialty Clinic.

Abstract

BACKGROUND\nThe Composite Asthma Severity Index (CASI) is a comprehensive tool to assess asthma severity that has been applied in the research setting.\n\n\nOBJECTIVE\nTo evaluate, in an outpatient setting, whether a CASI score accurately predicts asthma severity/control as determined via subspecialist assessment. Asthma Control Test (ACT) and childhood ACT (C-ACT) scores were generated to provide additional context for CASI scores in relationship to assessments using another clinical tool. Methods Children ages 5-18 years with a physician diagnosis of persistent asthma were recruited from a tertiary care center. A pediatric pulmonologist made determinations about each participant s asthma severity and control during a clinic visit. A CASI and ACT/C-ACT score were generated for each patient. Logistic regression and Spearman correlations were used to determine how well CASI scores predicted physician assessments. Agreement between ACT/C-ACT scores and physician assessment of asthma control was determined in supplemental analyses.\n\n\nRESULTS\nCASI scores strongly predicted physician assessment of severity (Spearman correlation 0.61, p-value <0.0001); unadjusted OR 36.67 (95% CI, 8.83 -152.34 ); and adjusted OR 32.76 (95% CI, 8 5.70-188.44 ). In supplemental analyses, ACT/C-ACT scores strongly predicted physician assessment of control (Spearman correlation 0.72, p-value <0.0001); unadjusted OR 42.12 (95% CI, 13.34 -133.00); and adjusted OR 55.34 (95% CI, 13.62 - 224.89).\n\n\nCONCLUSION\nUse of the CASI was feasible and accurately predicted physician assessments of asthma severity and control in this sample, which are not distinct entities. The CASI is a robust tool that may be used successfully in ambulatory pediatric asthma care.