Asthma Management Handbook
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Table. Risk factors for adverse asthma outcomes in adults and adolescents

 

Medical history

Investigation findings

Other factors

Factors associated with increased risk of flare-ups

Poor asthma control

Any asthma flare-up during the previous 12 months

Other concurrent chronic lung disease

Poor lung function (even if few symptoms)

Difficulty perceiving airflow limitation or the severity of flare-ups

Eosinophilic airway inflammation§

 

 

Exposure to cigarette smoke (smoking or environmental exposure)

Socioeconomic disadvantage

Use of illegal substances

Major psychosocial problems

Mental illness

Factors associated with increased risk of life-threatening asthma

Intubation or admission to intensive care unit due to asthma (ever)

2 or more hospitalisations for asthma in past year

3 or more ED visits for asthma in the past year

Hospitalisation or ED visit for asthma in the past month

High short-acting beta2 agonist use

  • Dispensing of 3 or more canisters in a year (average 1.6 puffs per day) is associated with increased risk of flare-ups in adults and children.
  • Dispensing 12 or more canisters in a year (average 6.6 puffs per day) is associated with increased risk of asthma death.

History of delayed presentation to hospital during flare-ups

History of sudden-onset acute asthma

Cardiovascular disease

Sensitivity to an unavoidable allergen (e.g. Alternaria species of common moulds)

Inadequate treatment

Experience of side-effects of OCS use (may contribute to under-treatment or delayed presentation to hospital during flare-ups)

Lack of written asthma action plan

Socioeconomic disadvantage

Living alone

Mental illness

Use of alcohol or illegal substances

Poor access to health care (e.g. rural/remote region)

Factors associated with accelerated decline in lung function

Chronic mucus hypersecretion

Severe asthma flare-up in a patient not taking ICS

Poor lung function

Eosinophilic airway inflammation§

Exposure to cigarette smoke (smoking or environmental exposure)

Occupational asthma

Factors associated with treatment-related adverse events

Long-term high-dose ICS

Frequent use of OCS

 

Anxiety disorder (due to increased sensitivity to asthma symptoms and reluctance to reduce ICS dose when asthma well controlled)

Euphoria with OCS use

§ White cell differential count on a peripheral blood sample is not currently recommended routinely in the investigation and management of asthma, but might be undertaken in the investigation of severe asthma to help guide biologic therapy.

 

Sources

Camargo CA, Rachelefsky G, Schatz M. Managing asthma exacerbations in the emergency department: summary of the National Asthma Education And Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations. Proc Am Thorac Soc 2009; 6: 357-66. Available from: http://www.atsjournals.org/doi/full/10.1513/pats.P09ST2

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. GINA; 2016. Available from: http://www.ginasthma.org/

Goeman DP, Abramson MJ, McCarthy EA et al. Asthma mortality in Australia in the 21st century: a case series analysis. BMJ Open 2013; 3: e002539. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657652

Osborne ML, Pedula KL, O'Hollaren M et al. Assessing future need for acute care in adult asthmatics: the profile of asthma risk study: a prospective health maintenance organization-based study. Chest 2007; 132: 1151-61. Available from: http://journal.publications.chestnet.org/article.aspx?articleid=1085456

Thomas M, Kay S, Pike J et al. The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey. Prim Care Respir J 2009; 18: 41-9. Available from: http://www.nature.com/articles/pcrj200910

Last reviewed version 2.0

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