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Asthma Attacks are Common and Serious

Asthma is a very common disease globally, and has a wide variety of manifestations and courses. However, any individual with asthma may experience a relatively rapid deterioration in their symptoms and measurements of their lung function (such as peak flow readings) that does not resolve with use of their reliever inhaler. These asthma attacks (severe exacerbations) are a common reason for seeking medical attention and often have long-lasting effects on an individual’s lungs and mental health. Sadly, they continue to be a preventable cause of loss of life, particularly in low and middle income countries. They are also costly, both for healthcare providers and for the individual who is taken away from work or study.

Using Future Risk in the Management of Asthma

Asthma management strategies have largely focussed on controlling symptoms, and reacting to a deterioration. Poor control of symptoms is a marker of future asthma attacks, but it doesn’t tell the whole story. This discrepancy between future risk and current symptoms can be particularly marked for some individuals. Additionally, some asthma treatments work well for symptoms but do not materially reduce risk, whereas others have the opposite profile.

Current guidelines do discuss future risk, but contain little practical information on how to assess this and then how to tailor treatment based on that information. This may be part of the reason that admissions for asthma have not fallen in the same way as we have seen for other conditions that have adopted a risk-based strategy (e.g. for heart attack prevention).

Developing a Risk Assessment Tool

There are a large number of academic publications that report single or grouped risk factors for asthma attacks. A simple risk questionnaire (The Asthma UK AAA Test) based on such published risk factors has generated substantial public interest. This risk assessment tool has been intended primarily as a conduit to health promotion opportunities. The relative effect importance of these risk factors and how they interact has not been well characterized.

An increasing amount of information on individuals is now held electronically in primary care records, and this is set to increase with newer interconnected “smart” devices. There is, therefore, an opportunity to assess an individual’s future risk of an asthma attack based on this information.

Aim of the study

We set out to use routinely collected characteristics from UK electronic medical records to describe baseline features that were more common in individuals that experienced multiple asthma attacks in the subsequent two years. We aimed to produce an overall estimate of an individuals’ risk (from these factors) when considered in combination. We then used this information to produce an on-line risk assessment tool.

Further details of the study and its results are available in this paper [link].
To learn more about the database used, click here [link].
To learn more about the Respiratory Effectiveness Group, click here

Key Findings
  • Asthma attacks are common, with a quarter of the 119 000 people in the study experiencing at least one episode in the two-year follow-up period.
  • Individuals at risk of multiple asthma attacks could be identified with a good degree of certainty (see figure).
  • Our findings were similar to previous studies in terms of the risk factors that were identified.
  • An overall risk assessment tool was developed and is available on-line
Using the Score
Clinical use

The online version of the risk assessment tool [link] is free and can be used by healthcare professionals reviewing people with asthma. It is intended to provide additional information to help inform asthma management decisions.

Research use

This score is free to use for research purposes, though should be appropriately cited in academic reports.

Limitations

The risk assessment tool reflects findings from a very large UK study population, but will not fully capture individual circumstances, particularly for people outside the UK. If you have asthma, please do not make any changes to your treatment without consulting your healthcare professional.

Further work

We acknowledge the need to validate this risk assessment tool outside the UK, and to improve its output to better guide healthcare workers and people with asthma. Further versions will become available in time.

Study Team
  • John D Blakey, Liverpool School of Tropical Medicine, UK
  • Mike Thomas, University of Southampton, UK
  • David B Price, University of Aberdeen, UK
  • Emilio Pizzichini, Federal University of Santa Catarina, Brazil
  • Todor A Popov, Medical University of Sofia, Bulgaria
  • Borislav D Dimitrov University of Southampton, UK
  • Dirkje S. Postma, University Medical Center Groningen, Netherlands
  • Lynn K. Josephs, University of Southampton, UK
  • Alan Kaplan, University of Toronto, Canada
  • Alberto Papi, University of Ferrara, Italy
  • Marjan Kerkhof, Respiratory Effectiveness Group, Cambridge, UK
  • Elizabeth V Hillyer, Respiratory Effectiveness Group, Cambridge, UK
  • Alison Chisholm, Respiratory Effectiveness Group, Cambridge, UK

The authors thank Ian D Pavord, Hilary Pinnock, Gene Colice, Alexandra Dima, Janet Holbrook, Cindy Rand, Iain Small, and Sam Walker for their valuable contributions to discussions about the study design. We thank Anne Burden, Vasilis Nikolaou, Victoria Thomas, and Maria Batsiou for contributions to the statistical analyses.

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