monitoring for the future risk of acute asthma attacks in adults and children

Last edited 11/2019 and last reviewed 11/2019

Monitoring:

Assess Risk of Future Attacks:

It is possible to identify adults and children (aged 5 and over) with asthma who are at increased risk of an asthma attack and to stratify the degree of risk associated with different markers.

  • Assess risk of future asthma attacks at every asthma review by asking about history of previous attacks, objectively assessing current asthma control, and reviewing reliever use.

  • In children, regard comorbid atopic conditions, younger age, obesity, and exposure to environmental tobacco smoke as markers of increased risk of future asthma attacks

    • greatly increased risk
      • a history of previous asthma attacks
      • persistent asthma symptoms

    • moderately increased risk
      • suboptimal drug regimen (the ratio of the number of prescriptions for controller medication to total number of prescriptions for asthma medication <0.5)
      • comorbid atopic/allergic disease
      • low-income family (1)
      • vitamin D deficiency (1)

    • slightly increased risk
      • younger age
      • exposure to environmental tobacco smoke
      • obesity
      • low parental education (1)

    • unclear (evidence equivocal) > reduced lung function, raised FeNO at routine reviews, positive skin-prick tests, history of allergen exposure

  • in adults, regard older age, female gender, reduced lung function, obesity, smoking, and depression as markers of a slightly increased risk of future asthma attacks
    • unclear (evidence limited or equivocal) of increasing risk of attacks -> history of anaphylaxis, comorbid gastro-oesophageal reflux, COPD, Raised FeNO at routine reviews, Blood eosinophilia, Poor adherence

Notes:

  • insufficient evidence in adults to say if the following factors are associated with an increased risk of future asthma attacks (1):
    • concomitant prescription of paracetamol or non-steroidal anti-inflammatory medicines,
    • deprivation,
    • being underweight,
    • frequent febrile upper respiratory tract infection,
    • diabetes,
    • pollution,
    • black or Indian ethnicity
    • stepping down ICS treatment

  • insufficient evidence in children to say if the following factors are associated with an increased risk of future asthma attacks (1):
    • serum total IgE,
    • family history of atopy,
    • age of onset of asthma,
    • duration of asthma,
    • comorbidities (gastro-oesophageal reflux disease, diabetes),
    • special needs,
    • parental health,
    • parental marital status

Reference:

  • SIGN (July 2019). British Guideline on the management of asthma (SIGN158)