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

Abstract

BACKGROUND

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

OBJECTIVE

To validate the ASSESS score in the All Age Asthma Cohort (ALLIANCE) and explore its use in children <12 years.

METHODS

Scale properties, responsiveness, and known-group validity were assessed in 247 children (median age 11 years, IQR: 8-13 years) and 206 adults (median age 52 years, IQR: 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 (SARP). Cronbach's α was 0.59 in children 12-18 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, as the ASSESS score was significantly worse in patients with poor asthma control, exacerbations and increased salbutamol use. In children between 6-11 years test reliability was inferior compared to adults and adolescents (Cronbach's α 0.27) mostly due to a less lung function impairment in asthmatic children of this age group. Known-group validity however confirmed good discriminative power regarding severity-associated variables similar to adolescents and adults.

CONCLUSION

Test reliability and validity of the ASSESS score was confirmed in the ALLIANCE cohort. In children aged 6-11 years internal consistency was inferior compared to older asthma patients, however test validity was good and encourages age-spanning usage of the ASSESS score in all asthma patients ≥ 6 years.