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

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)