Reliable quantitative score for grading chest X-ray using the dynamic of blood cell count in adult asthma

The purpose of the present study was to rate the level of spread of asthma-induced bronchial morphological changes on chest X-ray (CXR), using the modified Shwachman–Kulczycki (S–K) rating scale as predicted by the dynamic of blood cell count (CBC). A sample of 40 asthma patients’ records was classified into 4 groups based on their clinical presentations and frequency of their visits to the hospital; Group-1 ⩽2 visits per week with reversible symptoms, Group-2 ⩾2 visits per week with irreversible symptoms, Group-3: ⩾3–4 visits per week with irreversible symptoms; Group-4: patients with severe shortness of breath in whom SaO2 was threatening, hence were admitted as inpatients. Patients’ CXR were scored based on the modified Shwachman–Kulczycki (S–K) scale rating. Blood analysis showed that RBC and their indices (HCT, HGB, MCH, RDW) were highest in group-2. White blood cells and their derivatives (NEU, EOS and LYM) were highest in group 4. CXR for group-2 showed bilateral increased bronchovascular markings but normal both lung fields and ruled out for costo-phrenic angles type of fever. Chest X-ray for group-3 showed hyperinflation, perihilar marking associated with bronchial thickening and unfolding aorta. In patients in group-4 development of broncho-pneumonic infiltration type of SOB and some evidence of bronchial edema with significant (p < 0.05) elevation in WBC were observed. The regression of S–K score on the dynamic of some CBC parameters was significant (p < 0.05). The best subsets that describe the model were:S–K=14.242+β1NEU(-1.28)+β2EOS(-10.929)+β3HCT(0.577)+β4HGB(-.898)+β5RDW(0.546)+β6RBC(-1.966)+εBased on the results of the present study it can be concluded that monitoring CBC parameters can be an objective estimate of the S–K score for CXR in order to classify the severity of asthma using an objective numerical value to assess patients’ treatment follow up, without the need for X-ray equipment setup.