Utilidad clínica de los puntajes EXACTO y FEOS para evaluar la respuesta a terapia biológica en asma grave

Abstract

Background: The evaluation of response to biological therapy in severe asthma requires standar- dized tools that integrate symptoms, lung function, exacerbations, and use of systemic corticosteroids. EXACTO and FEOS are internationally validated composite scores, but there is little evidence in Latin American population. Objective: To evaluate the clinical utility of the EXACTO and FEOS scores in patients with severe asthma on biological therapy in a Chilean public hospital. Methods: A single- center retrospective observational study in patients >18 years with severe asthma who were followed up between 2017 and 2025. Clinical, functional, and exacerbation data were collected. EXACTO and FEOS were calculated at 16 weeks and 12 months according to original methodology. Paired compari- sons (Wilcoxon’s test) and correlations (Spearman’s coefficient) were conducted. Results: A total of28 patients (82.1% women; mean age 54.9 ± 11.5 years). Median baseline FEVi : 50% cf predicted (IQR 43-80); median exacerbations in the previous 12 months: 5 (IQR 3-7). At 16 weeks, there was impro- vement in clinical control (median ACT of 8 to 15; p < 0.001), reduction in systemic corticosteroids dose (median 10 to 5 mg; p < 0.01) and a improvement in pre-bronchodilator FEVi (~ 200 mL; p: ns). Conclusions: In a limited sample, EXACTO and FEOS were shown to be useful tools to assess the re- sponse to biological therapy in real-world severe asthma care. EXACTO showed significant improve- ment at 12 months (p = 0.045). FEOS showed a concordant trend. Clinical improvement was accom- panied by reduced use of systemic corticosteroids and sustained symptomatic improvement.