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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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)
    • no increased risk
      • gender
      • urban residence
    • 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:

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

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