ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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A proof-of-concept scale to predict asthma attacks: the OxfoRd Asthma attaCk risk ScaLE (ORACLE)
Session Title
TP10 - TP010 CLINICAL AND POPULATION-LEVEL STUDIES OF ASTHMA
Abstract
A1436 - A proof-of-concept scale to predict asthma attacks: the OxfoRd Asthma attaCk risk ScaLE (ORACLE)
Author Block: S. Couillard1, A. Laugerud2, M. Jabeen1, S. Ramakrishnan1, J. Melhorn1, T. S. C. Hinks1, I. D. Pavord1; 1Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, 2Sanofi Norway, Oslo, Norway.
RATIONALE: Reduction of the risk of asthma attacks is a major goal of current Global Initiative for Asthma (GINA) guidelines. OBJECTIVE: To develop a risk scale to predict asthma attacks based on the blood eosinophil count and exhaled nitric oxide. METHODS: Trial-level data were extracted from the Novel START, CAPTAIN, LIBERTY ASTHMA QUEST and DREAM trials. Attack rates for control or placebo-treated patients (n=1989) were stratified by blood eosinophils and exhaled nitric oxide in a 3×3 grid using cut-offs 0.15-0.30×109 cells/L and 25-50 ppb. Rate ratios and relative risks were used to derive biomarker-stratified multipliers for GINA treatment step attack rates derived from 222,817 patients. Other parameters included were a recent asthma attack history (≤1 year), ≥2 concurrent clinical risk factors*, and GINA treatment step. We compared predicted versus observed biomarker-stratified asthma attack rates in placebo-treated groups reported in 17 independent clinical trials. RESULTS: Biomarker-stratified asthma attack rates were multiplied by 0.64 in the lowest type 2 biomarker combination group and 1.96 in the highest. A previous asthma attack and/or having concurrent risk factors independently increased rates 2.8- and/or 1.4-fold, respectively. Predicted annual attack rates ranged from 0.06 in the lowest biomarker step 1&2 patients to 2.4 in the highest biomarker step 5 patients. The resultant scale is shown in Figure 1. There was close agreement between observed and predicted asthma attack rates (intraclass correlation coefficient 0.80; 95% CI 0.56-0.90). CONCLUSION: Our prototype scale based on biomarkers of type 2 airway inflammation proves feasibility and shows potential to predict asthma attacks which can be prevented by anti-inflammatory treatment.
FIGURE 1. Prototype Oxford Asthma Attack Risk ScaLE (ORACLE). Numbers in each cell are predicted annual asthma attack rates for patients over the age of 12. An asthma attack is an episode of acute asthma requiring treatment with systemic steroids ≥ 3 days. Blood eosinophil count is contemporaneous or the highest result in last 12 months; fractional exhaled nitric oxide level is contemporaneous. *Risk factors are GINA-defined: poor symptom control, low lung function, adherence issues, reliever over-use, intubation or intensive care unit admission for asthma previously, comorbidities (chronic rhinosinusitis, obesity, psychiatric disease), environmental exposures (smoking, allergen, pollution).
Author Block: S. Couillard1, A. Laugerud2, M. Jabeen1, S. Ramakrishnan1, J. Melhorn1, T. S. C. Hinks1, I. D. Pavord1; 1Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, 2Sanofi Norway, Oslo, Norway.
RATIONALE: Reduction of the risk of asthma attacks is a major goal of current Global Initiative for Asthma (GINA) guidelines. OBJECTIVE: To develop a risk scale to predict asthma attacks based on the blood eosinophil count and exhaled nitric oxide. METHODS: Trial-level data were extracted from the Novel START, CAPTAIN, LIBERTY ASTHMA QUEST and DREAM trials. Attack rates for control or placebo-treated patients (n=1989) were stratified by blood eosinophils and exhaled nitric oxide in a 3×3 grid using cut-offs 0.15-0.30×109 cells/L and 25-50 ppb. Rate ratios and relative risks were used to derive biomarker-stratified multipliers for GINA treatment step attack rates derived from 222,817 patients. Other parameters included were a recent asthma attack history (≤1 year), ≥2 concurrent clinical risk factors*, and GINA treatment step. We compared predicted versus observed biomarker-stratified asthma attack rates in placebo-treated groups reported in 17 independent clinical trials. RESULTS: Biomarker-stratified asthma attack rates were multiplied by 0.64 in the lowest type 2 biomarker combination group and 1.96 in the highest. A previous asthma attack and/or having concurrent risk factors independently increased rates 2.8- and/or 1.4-fold, respectively. Predicted annual attack rates ranged from 0.06 in the lowest biomarker step 1&2 patients to 2.4 in the highest biomarker step 5 patients. The resultant scale is shown in Figure 1. There was close agreement between observed and predicted asthma attack rates (intraclass correlation coefficient 0.80; 95% CI 0.56-0.90). CONCLUSION: Our prototype scale based on biomarkers of type 2 airway inflammation proves feasibility and shows potential to predict asthma attacks which can be prevented by anti-inflammatory treatment.
FIGURE 1. Prototype Oxford Asthma Attack Risk ScaLE (ORACLE). Numbers in each cell are predicted annual asthma attack rates for patients over the age of 12. An asthma attack is an episode of acute asthma requiring treatment with systemic steroids ≥ 3 days. Blood eosinophil count is contemporaneous or the highest result in last 12 months; fractional exhaled nitric oxide level is contemporaneous. *Risk factors are GINA-defined: poor symptom control, low lung function, adherence issues, reliever over-use, intubation or intensive care unit admission for asthma previously, comorbidities (chronic rhinosinusitis, obesity, psychiatric disease), environmental exposures (smoking, allergen, pollution).
