Validation of the adult asthma epidemiological score: a secondary analysis of the EPI-ASTHMA population-based study.

Data de publicação: 02/11/2024 Data Ahead of Print: 02/11/2024

Autores da FMUP

• Cristina Isabel Oliveira Jácome

  Autor

• Rita Da Silva Amaral

  Autor

• João De Almeida Lopes Da Fonseca

  Autor

Participantes de fora da FMUP

• Laranjeira C
• Bernardo F
• Correia-de-Sousa J

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

OBJECTIVE: The A2 score is an eight-question patient-reported outcome measure that has been validated for ruling in (score =4) and ruling out (score 0-1) asthma. However, this screening tool has been validated in a cohort similar to the derivation cohort used. This study aims to validate the predictive accuracy of the A2 score in a primary care population against general practitioner (GP) clinical assessment and to determine whether the proposed cut-offs are the most appropriate. DESIGN: This accuracy study is a secondary analysis of the EPI-ASTHMA population-based study. SETTING: Primary care centres in Portugal. PARTICIPANTS: Random adult participants answered the A2 score by phone interview. OUTCOMES: Those with an A2 score =1 (plus 5% with an A2 score of 0) were invited to a diagnostic visit carried out by a GP to confirm or not a diagnosis of asthma. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves. RESULTS: A total of 1283 participants (median 54 (p25-p75 43-66) years; 60% women) were analysed. The A2 score showed high discriminatory power in identifying asthma, with an area under the ROC curve of 82.9% (95% CI 80.4% to 85.4%). The proposed cut-off =4 was the most appropriate to rule in asthma (specificity 83.1%, positive predictive value 62.4%, accuracy 78%). Similarly, the proposed cut-off<2 was the most suitable for excluding asthma (sensitivity 92.7%, negative predictive value 93.7%, accuracy 60.5%). CONCLUSIONS: The A2 score is a useful tool to identify patients with asthma in a primary care population. TRIAL REGISTRATION NUMBER: NCT0516961.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

• Asthma; Epidemiology; Patient Reported Outcome Measures