Section 3:

Identifying patients at risk of poor outcomes
Risk factors for exacerbations

GINA states that having any of the following risk factors increases the patient’s risk of asthma attacks, even if they have few asthma symptoms1

  • Uncontrolled asthma symptoms
  • Medications: high SABA use (increased mortality if >1 x 200-dose inhaler per month); inadequate ICS – ICS not prescribed, poor adherence and/or incorrect inhaler technique
  • Comorbidities: obesity, chronic rhinosinusitis, gastro-oesophageal reflux disease (GORD); confirmed food allergy; pregnancy
  • Exposures: smoking, allergen exposure if sensitised, air pollution
  • Major psychological or socioeconomic problems
  • Lung function: low FEV1, especially <60% predicted; high bronchodilator reversibility
  • Blood eosinophils, elevated fractional exhaled nitric oxide (FeNO)
  • Ever intubated or in intensive care for asthma
  • ≥1 severe exacerbation in the last 12 months

The BTS/SIGN British Guideline on the Management of Asthma says it is possible to identify adults with asthma at increased risk of an asthma attack.2

The guideline also suggests that it is possible to stratify risk, with history of previous asthma attacks associated with greatly increased risk; risk is moderately increased with poor control (assessed objectively at every review) and inappropriate or excessive use of SABA; risk is slightly increased in older age, females, reduced lung function, obesity, smoking and depression. BTS/SIGN considers the level of increased risk unclear for patients with a history of anaphylaxis, comorbid GORD, COPD, raised FeNO at routine review, blood eosinophilia, or poor adherence.2

The main factors associated with increased risk of future asthma attacks in school-age children include previous history of asthma attacks, persistent symptoms, suboptimal drug regimen, comorbid atopic/allergic disease, and low-income family.2

Job code: UK/RES-19014e DOP: May 2020


  1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention; 2019. [Accessed May 2020]
  2. BTS/SIGN British Guideline on the Management of Asthma; 2019. [Accessed May 2020]