Peer-reviewed article
The School-age Asthma Prognosis Score (SAPS): development and external validation in two European cohorts
Makhoul R, Goutaki M, Romero F, Sasaki M, Hansen G et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study developed and validated a clinical prediction tool called the School-age Asthma Prognosis Score (SAPS) to help identify which children with asthma are likely to achieve remission. The tool uses simple information from patient history including sex, symptom patterns, triggers, and family history of asthma. It was created using data from 1,860 Swiss children with asthma and tested in a separate German cohort, showing consistent ability to predict remission outcomes. This allows doctors to better monitor children who have lower chances of recovering from asthma.
Key points
- The SAPS retained 8 variables: sex, wheeze frequency, night-time awakening, exercise-induced wheeze, pollen-triggered wheeze, animal-triggered wheeze, maternal asthma, and paternal asthma
- Clinical remission was defined as absence of wheeze and inhaler use during the past 12 months, measured 2-3 years after diagnosis
- The tool achieved moderate discriminative ability with AUC 0.71 in both the development cohort and external validation
- The prediction tool is based only on clinical history without requiring lung function testing
- It enables closer monitoring of children with lower chances for remission
Limitations
The study is limited to European populations (Switzerland and Germany) and may not generalize to other regions. The document does not provide information on the tool's clinical utility or how it performs in routine practice settings.
Abstract
Prediction models for asthma remission in school-age are lacking, limiting clinicians’ ability to tailor follow-up. Most prediction tools focus on pre-school diagnosis or require lung function testing. We developed and validated a simple, history-based clinical prediction tool for asthma remission. We analyzed prospective data from the Swiss Paediatric Airway Cohort (SPAC), including 1860 children (aged 5-16 years) with physician-diagnosed asthma. We derived asthma remission predictors from parental questionnaires capturing demographics, symptoms, triggers, and family history. We defined clinical remission at 2-3 years following asthma diagnosis, as absence of wheeze and inhaler use during the past 12 months. We developed the model using LASSO regression with multiple imputations for missing data, and assessed its performance by area under the curve (AUC), Hosmer-Lemeshow (HL) test, and calibration plots. We then derived a simplified score and validated it in the German All-Age Asthma Cohort (ALLIANCE). From 12 candidate variables, the final score retained: sex, wheeze frequency, night-time awakening, exercise-induced wheeze, pollen-triggered wheeze, animal-triggered wheeze, maternal asthma, and paternal asthma. The score demonstrated moderate discrimination in the development cohort (AUC 0.71) and maintained discriminative ability in the external validation (AUC 0.71). This practical, prognostic tool for asthma remission based only on clinical history, allows clinicians to identify children who have lower chances for remission, enabling their closer monitoring. Abstract Figure