Validation of the Asthma Severity Scoring System (ASSESS) in the ALLIANCE Cohort

Ruth Grychtol; Lennart Riemann; Svenja Gaedcke; Bin Liu; David DeLuca; Reinhold Förster; Nicole Maison; Dominik Thiele; Nikolas Jakobs; Thomas Bahmer; Meike Meyer; Svenja Foth; Stefanie Weber; Ernst Rietschel; Klaus F Rabe; Matthias V Kopp; Erika von Mutius; Anna-Maria Dittrich; Gesine Hansen; ALLIANCE Study Group as part of the German Center for Lung Research (DZL)

doi:10.1016/j.jaci.2023.01.027

Validation of the Asthma Severity Scoring System (ASSESS) in the ALLIANCE Cohort

J Allergy Clin Immunol. 2023 Jun;151(6):1525-1535.e4. doi: 10.1016/j.jaci.2023.01.027. Epub 2023 Feb 15.

Authors

Ruth Grychtol¹, Lennart Riemann², Svenja Gaedcke³, Bin Liu³, David DeLuca³, Reinhold Förster⁴, Nicole Maison⁵, Dominik Thiele⁶, Nikolas Jakobs⁷, Thomas Bahmer⁸, Meike Meyer⁹, Svenja Foth¹⁰, Stefanie Weber¹⁰, Ernst Rietschel⁹, Klaus F Rabe¹¹, Matthias V Kopp¹², Erika von Mutius⁵, Anna-Maria Dittrich¹, Gesine Hansen¹³; ALLIANCE Study Group as part of the German Center for Lung Research (DZL)

Collaborators

ALLIANCE Study Group as part of the German Center for Lung Research (DZL):
Oliver Fuchs, Barbara Roesler, Nils Welchering, Naschla Kohistani-Greif, Johanna Kurz, Katja Landgraf-Rauf, Kristina Laubhahn, Nicole Maison, Claudia Liebl, Bianca Schaub, Markus Ege, Erika von Mutius, Sabina Illi, Alexander Hose, Esther Zeitlmann, Mira Berbig, Carola Marzi, Christina Schauberger, Ulrich Zissler, Carsten Schmidt-Weber, Isabell Ricklefs, Gesa Diekmann, Lena Liboschik, Gesche Voigt, Laila Sultansei, Markus Weckmann, Matthias V Kopp, Gyde Nissen, Inke R König, Dominik Thiele, Thomas Bahmer, Anne-Marie Kirsten, Frauke Pedersen, Henrik Watz, Benjamin Waschki, Klaus F Rabe, Christian Herzmann, Mustafa Abdo, Heike Biller, Karoline I Gaede, Xenia Bovermann, Alena Steinmetz, Berrit Liselotte Husstedt, Catharina Nitsche, Vera Veith, Marlen Szewczyk, Folke Brinkmann, Anna-Maria Dittrich, Christine Happle, Ruth Grychtol, Aydin Malik, Nicolaus Schwerk, Christian Dopfer, Mareike Price, Gesine Hansen, Adan Chari Jirmo, Anika Habener, Dipl-Biol, David S DeLuca, Svenja Gaedcke, Bin Liu, Mifflin-Rae Calveron, Stefanie Weber, Svenja Foth, Chrysanthi Skevaki, Harald Renz, Meike Meyer, Tom Schildberg, Ernst Rietschel, Silke van Koningsbruggen-Rietschel, Miguel Alcazar

Affiliations

¹ Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
² Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Else Kröner-Fresenius Stiftung, Forschungskolleg TITUS, Hannover Medical School, Hannover, Germany; Institute of Immunology, Hannover Medical School, Hannover, Germany.
³ Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
⁴ Institute of Immunology, Hannover Medical School, Hannover, Germany; Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy-EXC 2155 "RESIST", Germany.
⁵ Institute for Asthma and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany; Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany; Comprehensive Pneumology Center-Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
⁶ Institute of Medical Biometry and Statistics, University Medical Center Schleswig-Holstein, Luebeck, Germany; Airway Research Center North (ARCN), Member of German Center for Lung Research (DZL), Germany.
⁷ Airway Research Center North (ARCN), Member of German Center for Lung Research (DZL), Germany; Section for Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Luebeck, Germany.
⁸ Airway Research Center North (ARCN), Member of German Center for Lung Research (DZL), Germany; Department of Internal Medicine I, Pneumology, University Hospital Schleswig-Holstein, Kiel, Germany; LungenClinic Grosshansdorf, Grosshansdorf, Germany.
⁹ Faculty of Medicine, University Children's Hospital, University of Cologne, Cologne, Germany.
¹⁰ Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany; University Children's Hospital Marburg, University of Marburg, Marburg, Germany.
¹¹ Airway Research Center North (ARCN), Member of German Center for Lung Research (DZL), Germany; LungenClinic Grosshansdorf, Grosshansdorf, Germany.
¹² Airway Research Center North (ARCN), Member of German Center for Lung Research (DZL), Germany; Section for Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Luebeck, Germany; Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.
¹³ Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany; Else Kröner-Fresenius Stiftung, Forschungskolleg TITUS, Hannover Medical School, Hannover, Germany; Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy-EXC 2155 "RESIST", Germany. Electronic address: hansen.gesine@mh-hannover.de.

PMID: 36804993
DOI: 10.1016/j.jaci.2023.01.027

Abstract

Background: The Asthma Severity Scoring System (ASSESS) quantifies asthma severity in adolescents and adults. Scale performance in children younger than 12 years is unknown.

Objective: To validate the ASSESS score in the All Age Asthma Cohort and explore its use in children younger than 12 years.

Methods: Scale properties, responsiveness, and known-group validity were assessed in 247 children (median age, 11 years; interquartile range, 8-13 years) and 206 adults (median age, 52 years; interquartile range, 43-63 years).

Results: Overall, measures of internal test consistency and test-retest reliability were similar to the original data of the Severe Asthma Research Program. Cronbach α was 0.59 in children aged 12 to 18 years and 0.73 in adults, reflecting the inclusion of multiple and not-always congruent dimensions to the ASSESS score, especially in children. Analysis of known-group validity confirmed the discriminatory power, because the ASSESS score was significantly worse in patients with poor asthma control, exacerbations, and increased salbutamol use. In children aged 6 to 11 years, test-retest reliability was inferior compared with that in adults and adolescents (Cronbach α, 0.27) mostly because of a less lung function impairment in children with asthma of this age group. Known-group validity, however, confirmed good discriminative power regarding severity-associated variables similar to adolescents and adults.

Conclusions: Test-retest reliability and validity of the ASSESS score was confirmed in the All Age Asthma Cohort. In children aged 6 to 11 years, internal consistency was inferior compared with that in older patients with asthma; however, test validity was good and thus encourages age-spanning usage of the ASSESS score in all patients 6 years or older.

Keywords: ALLIANCE; adult asthma; asthma; asthma control; asthma severity; children; pediatric asthma; validation study.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Asthma* / diagnosis
Child
Humans
Middle Aged
Reproducibility of Results
Surveys and Questionnaires