TOPLINE:

The Asthma Clinical Score (ACS) demonstrated moderate reliability in both children with obesity and those with normal weight, whereas the Pediatric Respiratory Assessment Measure (PRAM) performed more weakly in children with obesity. Despite adjustment for severity scores, children with obesity were more likely to receive intensive treatments.

METHODOLOGY:

• In a secondary analysis of a prospective study, researchers evaluated the performance of two asthma severity scores in children with obesity and those with normal weight who were presented with asthma exacerbations in the pediatric emergency department.
• They assessed 399 children (60% boys), including 288 with normal weight and 111 with obesity, defined as a sex-specific weight-for-age above the 95th percentile.
• Asthma severity was assessed using the ACS and PRAM scores, with higher scores indicating greater severity, and scores were compared between both children with obesity and those with normal weight.
• The primary objective was to evaluate interrater reliability (IRR), responsiveness, and the ability to predict hospital admission for two asthma severity scores in children with obesity vs those with normal weight. The secondary objective was to examine the association between ED treatments and disposition in these groups.

TAKEAWAY:

• The ACS demonstrated moderate IRR in both children with normal weight (IRR, 0.77; 95% CI, 0.71-0.83) and those with obesity (IRR, 0.79; 95% CI, 0.70-0.88). In contrast, the PRAM showed moderate IRR in children with normal weight (IRR, 0.73; 95% CI, 0.65-0.82) but weak IRR in those with obesity (IRR, 0.57; 95% CI, 0.40-0.74).
• Children with obesity showed reduced responsiveness, as detected by both scores: In children with obesity vs normal weight, a reliable change in the ACS was observed among 23% vs 34%, and a reliable change in the PRAM was observed in 3.7% vs 28%.
• For both scores, predictive validity for hospital admission was higher in children with obesity than in those with normal weight (ACS area under the receiver operating characteristic curve [AUROC], 0.85 vs 0.74; PRAM AUROC, 0.79 vs 0.72).
• Children with obesity had significantly higher odds of receiving intravenous methylprednisolone, continuous albuterol, and bilevel positive airway pressure ventilation than children with normal weight.

IN PRACTICE:

“Evaluating the IRR of asthma severity scores is important to ensure consistency of assessments between providers, as these assessments impact clinical decision-making,” the authors of the study wrote.

SOURCE:

The study was led by Adjoa A. Andoh, MD, Nationwide Children’s Hospital, Columbus, Ohio. It was published online on December 27, 2025, in the Journal of Asthma.

LIMITATIONS:

The study was limited by its single-site design, the use of sex-specific weight-for-age instead of BMI, and the absence of data on provider experience and number of assessments, possibly introducing misclassification and measurement bias. Additionally, because the study was a planned secondary analysis, it was underpowered to detect differences in IRR, predictive validity, and responsiveness.

DISCLOSURES:

The study was supported by the Clinical and Translational Intramural Funding Program from the Abigail Wexner Research Institute at Nationwide Children’s Hospital. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.