Predicción del riesgo de exacerbaciones según ORACLE (Oxford Asthma Attack Risk Scale) en pacientes chilenos con asma grave tratados con terapia biológica

Abstract

Background: Specifying the risk of asthma exacerbations is essential in terms of morbidity and mortality. Objective: To evaluate the risk of exacerbations in asthmatic patients from the Severe Asthma Program of the Instituto Nacional del Tórax (INT), using the ORACLE scale, after one year of biologi­cal therapy. Patients and Method: Asthmatic patients on biological therapy who had exhaled fraction of nitric oxide (FeNO) and blood eosinophil count at the beginning of therapy were selected. The ORACLE scale was applied retrospectively, before and after one year of biological therapy. Results: The clinical records of 31 patients on biological therapy from the Severe Asthma program of the INT were reviewed. 17 patients had FeNO and blood eosinophil count. Average age was 56.2 years (range 33-70 years). The risk of exacerbations evaluated with both biomarkers, according to the ORACLE scale prior to the start of biological therapy, was 1.57 ± 0.68. A risk reduction was observed to 0.84 ± 0.32 (p < 0.05) after one year of therapy. The same ORACLE scale, applied only with blood eosinophil count, estimated a risk prior to the use of biologicals of 1.37 ± 0.42 exacerbations, which was reduced to 0.97 ± 0.39 after one year of treatment (p < 0, 05). There were no significant differences between both estimated risks of exacerbations prior to biological therapy (p = NS). Conclusions: The application of the ORACLE scale is efficient in evaluating the risk of exacerbations using biomarkers such as FeNO and blood eosinophil count, and without differences in estimation only with eosinophil count.