The novel ORACLE scale (Oxford Asthma Attack Risk Scale) demonstrated potential to predict — and subsequently prevent — asthma attacks using biomarkers of type 2 airway inflammation, according to research presented at the American Thoracic Society (ATS) 2021 International Conference, held virtually from May 14 to May 19, 2021.

Researchers sought to develop an effective risk scale to predict asthma attacks based on blood eosinophil count and exhaled nitric oxide. Trial-level data from 4 clinical trials — Novel START, CAPITAN, LIBERTY ASTHMA QUEST, and DREAM — were used to develop the scale.

Investigators analyzed and stratified attack rates for patients who received placebo  (n=1989) by blood eosinophil and exhaled nitric oxide levels in a 3×3 grid with cut-off points of 0.15-0.30×109 cells/L and 25 to 50 ppb, respectively. From there, rate ratios and relative risks were used to derive biomarker-stratified multipliers for Global Initiative for Asthma (GINA) treatment step attack rates from 222,817 patients. 

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Biomarker-stratified asthma attack rates were then multiplied by 0.64 and 1.96 in the lowest and highest type 2 biomarker combination groups, respectively. History of a previous asthma attack and/or the presence of concurrent risk factors led to independently increased rates of 2.8-fold and/or 1.4-fold, respectively.

In the lowest biomarker step 1 and 2 patients, predicted annual attack rates were 0.06; in the highest biomarker step 5 patients, this risk was 2.4. Investigators noted a close agreement between observed and predicted asthma attack rates (intraclass correlation coefficient, 0.80; 95% CI, 0.56-0.90).

“Our prototype scale based on biomarkers of type 2 airway inflammation proves feasibility and shows potential to predict asthma attacks which can be prevented by anti-inflammatory treatment, the researchers concluded.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Couillard S, Laugerud A, Jabeen M, et al. A proof-of-concept scale to predict asthma attacks: The OxfoRd Asthma attack risk ScaLE (ORACLE). Presented at: the American Thoracic Society (ATS) 2021 International Conference; May 14-19, 2021. Abstract A1436.

This article originally appeared on Pulmonology Advisor