Risk factors for adverse asthma outcomes

Assess patients with asthma for risk factors for adverse asthma outcomes, including exacerbations, faster than normal decline in lung function and adverse effects of treatment.

Risk factors associated with adverse asthma outcomes are listed in Risk factors for adverse asthma outcomes in adults and adolescents. Minimise or manage any modifiable risk factors, and consider reviewing patients at risk of adverse outcomes more frequently.

Table 1. Risk factors for adverse asthma outcomes in adults and adolescents
Risk factors for exacerbations
poor adherence inadequate inhaler technique poor asthma symptom control any asthma exacerbation during the previous 12 months lack of written asthma action plan difficulty perceiving airflow limitation or severity of exacerbation poor lung function (even if few symptoms) peripheral blood eosinophilia (suggests eosinophilic airway inflammation) elevated FeNO exposure to tobacco smoke (personal or second-hand smoking) socioeconomic disadvantage use of illegal substances major psychosocial problems mental illness other chronic lung disease high bronchodilator reversibility allergic rhinitis or rhinosinusitis obesity
Risk factors for life-threatening asthma
intubation or admission to intensive care unit because of asthma (ever) two or more hospitalisations for asthma in the past year three or more ED visits for asthma in the past year hospitalisation or ED visit for asthma in the past month high SABA use (use of three or more canisters per year is associated with increased risk of exacerbation; use of more than 12 canisters per year is associated with increased risk of asthma-related death) history of delayed presentation to hospital during exacerbations history of sudden-onset acute asthma lack of written asthma action plan sensitivity to an unavoidable allergen (eg Alternaria species of common moulds) confirmed food allergy inadequate treatment experience of adverse effects of oral corticosteroids (may contribute to under treatment or delayed presentation to hospital during exacerbations) socioeconomic disadvantage living alone mental illness use of alcohol or illegal substances poor access to health care (eg rural or remote region) cardiovascular disease
Risk factors for accelerated decline in lung function
chronic mucus hypersecretion severe asthma exacerbation in a patient not using ICS occupational asthma poor lung function peripheral blood eosinophilia (suggests eosinophilic airway inflammation) exposure to tobacco smoke (personal or second-hand smoking)
Risk factors for treatment-related adverse events
long-term high-dose ICS frequent use of oral corticosteroids anxiety disorder (may be associated with increased sensitivity to asthma symptoms and reluctance to reduce ICS dose when asthma is well controlled) euphoria with oral corticosteroid use
Note: ED = emergency department; FeNO = fractional exhaled nitric oxide; ICS = inhaled corticosteroid; SABA = short-acting beta₂ agonist. Adapted from the Australian Asthma Handbook © 2020 National Asthma Council Australia. Accessed 31 August 2020.