Development and validation of a score assessing the risk of severe asthma in primary care

To develop and validate the Asthma Severity-Health Search (AS-HScore), predicting severe asthma risk in Italian primary care. According to the current asthma treatment guidelines, the AS-HScore intended to serve as a clinical decision support system (CDSS) for General Practitioners (GPs).

Using the Health Search Database (HSD), a cohort of 32,917 asthma-diagnosed patients between 2013 and 2021 was identified. The AS-HScore was developed using multivariable Cox regression in a two-part cohort: development and validation. Candidate determinants were estimated and linearly combined to form the score; its predictive accuracy was evaluated in the validation sub-cohort.

AS-HScore performance in the validation cohort revealed a 73% area under the curve (i.e. discrimination power) and a 22% pseudo-R² (explained variation). Calibration slope of 1.07 indicated strong calibration without rejecting the equivalence hypothesis (p = 0.157). Estimating a mean 10% (SD: 6.8%) 1-year risk of severe asthma, GPs might be provided with risk thresholds for patient categorization.

The AS-HScore emerges as an accurate tool predicting severe asthma risk in the Italian primary care. It therefore shows promising application to enhance asthma care by early identification of severe cases. Implementing a score-based CDSS for Italian GPs holds potential for significantly improving asthma management and patients' outcomes.