Risk Factors for Severe Asthma Exacerbation

Key Principles and Risk Factors

Asthma patients at all levels of severity are at risk for severe exacerbations, though certain high-risk factors dramatically increase this risk regardless of baseline asthma severity, as identified by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 1, 2
Severe exacerbations can occur in patients at any level of asthma severity—intermittent, mild persistent, moderate persistent, or severe persistent asthma, according to the NAEPP Expert Panel Report 3 2

Previous severe exacerbation (intubation or ICU admission for asthma) is a risk factor for future severe exacerbations, as noted by the NAEPP Expert Panel Report 3 1, 2, 3
Two or more hospitalizations for asthma in the past year increase the risk of severe exacerbations, as identified by the NAEPP Expert Panel Report 3 1, 2, 3
Three or more ED visits for asthma in the past year are associated with a higher risk of severe exacerbations, according to the NAEPP Expert Panel Report 3 1, 2, 3
Hospitalization or ED visit for asthma in the past month is a risk factor for future severe exacerbations, as noted by the NAEPP Expert Panel Report 3 1, 3
Using more than 2 canisters of short-acting beta-agonist (SABA) per month indicates overreliance on rescue medication and increases the risk of severe exacerbations, as identified by the NAEPP Expert Panel Report 3 1, 2, 3
Difficulty perceiving asthma symptoms or severity of exacerbations is a risk factor for severe exacerbations, according to the NAEPP Expert Panel Report 3 1, 2, 3
Lack of a written asthma action plan increases the risk of severe exacerbations, as noted by the NAEPP Expert Panel Report 3 1, 3
Sensitivity to Alternaria (a specific allergen) is a risk factor for severe exacerbations, as identified by the NAEPP Expert Panel Report 3 1, 3

Low socioeconomic status or inner-city residence is a risk factor for severe exacerbations, according to the NAEPP Expert Panel Report 3 1, 2, 3
Illicit drug use increases the risk of severe exacerbations, as noted by the NAEPP Expert Panel Report 3 1, 2, 3
Major psychosocial problems or psychiatric disease are risk factors for severe exacerbations, as identified by the NAEPP Expert Panel Report 3 1, 2, 3

Cardiovascular disease is a risk factor for severe exacerbations, according to the NAEPP Expert Panel Report 3 1, 2, 3
Other chronic lung disease increases the risk of severe exacerbations, as noted by the NAEPP Expert Panel Report 3 1, 2, 3
Chronic psychiatric disease is a risk factor for severe exacerbations, as identified by the NAEPP Expert Panel Report 3 1, 3

The most dangerous clinical error is underestimating exacerbation severity or assuming that patients with well-controlled baseline asthma are not at risk, as warned by the NAEPP Expert Panel Report 3 2