Bronchiectasis Severity Index (BSI) and FACED are prediction tools that can provide clinically relevant evaluations of bronchiectasis severity, mortality and several other outcomes that may influence clinical decision-making processes and promote better management of the patients’ symptoms.

Findings from a recent study, “Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts,” published in the journal Thorax, showed that BSI has a much higher predictive value than the FACED score.

Because no licensed therapies exist currently for bronchiectasis and most patients are treated with antibiotics-based therapies, it is important that patients at severe risk are identified to avoid over-treatment of mild conditions.

The BSI and the FACED score both classify patients into low, moderate, and high risk groups. Both tools attribute points according to age, FEV1% (a measure of lung function), Pseudomonas aeruginosa infection, type of bronchiectasis, degree of shortness of breath, and radiological findings. In addition, BSI also considers body mass index, prior hospitalization for severe exacerbation, exacerbation frequency, and chronic bacterial infection (other than P. aeruginosa).

Although both scores can predict mortality in bronchiectasis that measure is not the most important for assessing disease impact. Other clinical outcomes such as hospital admissions, exacerbations, quality of life, respiratory symptoms, lung function decline, and exercise capacity are more likely to help identify patients who are not only at high risk of frequent exacerbations or rapid lung function decline, but also patients who are low-risk and could receive simpler treatments.

For the recent study, researchers at Galway University Hospitals, in Ireland, and colleagues sought to compare the predictive use of BSI and FACED in assessing clinically relevant disease outcomes. The team assessed 1,612 patients from seven diverse European cohorts.

Results showed that both tools had a good discriminatory predictive value for mortality, with BSI demonstrating higher sensitivity, but lower specificity. FACED was found to consistently overestimate mortality in severe patients across all cohorts.

The study also revealed that contrary to FACED, BSI accurately predicted hospital admissions, exacerbations, health-related quality of life, respiratory symptoms, 6-minute walking distance scores, and lung function decline in bronchiectasis. FACED was poor in predicting hospital admissions and had no association with the remaining clinical outcomes.

The findings suggested that while BSI is more complex and requires measuring more clinical parameters, it is superior to FACED in predicting clinical outcomes and may be more relevant to improving the health management of bronchiectasis patients.