Researchers have created a tool for predicting mortality in bronchiectasis patients based on the number and severity of disease exacerbations. The method can also predict how many disease-worsening episodes a patient can expect over a year, and in so doing, identify patients in special need of preventive treatment.
A method to accurately predict such flares is also needed to evaluate if a treatment is effective during clinical trials.
The study, “Predicting high risk of exacerbations in bronchiectasis: the E-FACED score,” appeared in the International Journal of COPD.
Several tools to assess disease severity and prognosis of bronchiectasis now exist, but researchers at Spain’s Polytechnic and University La Fe Hospital and their colleagues at Brazil’s Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo realized that none of the scoring tools adequately predict disease exacerbations.
Using a previously developed scale called FACED, researchers added data from 819 patients and experimented to see what kind of information best predicted future episodes.
FACED takes into account forced expiratory volume in one second (FEV1; a measure of lung function), age, chronic colonization by the bacteria Pseudomonas aeruginosa, the number of lung lobes affected, and the presence of dyspnea (shortness of breath). Each item is scored so that the total score falls between zero and seven.
Adding information about the number of hospitalizations — at least one, at least two, or at least three hospitalizations in the previous year — improved the predictive power of the FACED scale only moderately.
Researchers then added information about exacerbations, defined as a worsening of airway symptoms along with increased sputum production that required antibiotic treatment. The team discovered that adding the term “at least one exacerbation” best improved the FACED score.
To be sure that the new score, which they called E-FACED, really did predict future flares, the team tested the new scale on another group of 651 patients, whom they followed over time.
Researchers showed that adding the new item improved predictions compared to FACED, and was most accurate in people with more episodes. It was also better than the old tool at predicting mortality. Furthermore, the expanded scale did equally well in categorizing patients into different severity groups.
“E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score’s simplicity and prognostic capacity for death,” the researchers concluded.
Since exacerbations are potentially preventable and also drive disease progression, the new tool may help identify patients most in need of interventions and prevent their condition from worsening.