Predicting asthma exacerbations in children

Abstract

Purpose of review: This review critically assesses recently published literature on predicting asthma exacerbations in children, while also providing general recommendations for future research in this field.

Recent findings: Current evidence suggests that every effort should be made to provide optimal treatment to achieve adequate asthma control, as this will significantly reduce the risk of severe disease exacerbations. Children who have had at least one asthma exacerbation in the previous year are at highest risk for subsequent exacerbations, regardless of disease severity and/or control. Although several tools and biomarkers to predict asthma exacerbations have been recently developed, these approaches need further validation and/or have only had partial success in identifying children at risk.

Summary: Although considerable progress has been made, much remains to be done. Future studies should clearly differentiate severe asthma exacerbations due to inadequate asthma control from those occurring in children whose asthma is well controlled, utilize standardized definitions of asthma exacerbations, and use a systematic approach to identify the best predictors after accounting for the multiple dimensions of the problem. Our ability to correctly predict the development of severe asthma exacerbations in an individual child should improve in parallel with increased knowledge and/or understanding of the complex interactions among genetic, environmental (e.g. viral infections) and lifestyle (e.g. adherence to treatment) factors underlying these events.

Figure 1. Asthma Exacerbation Clinical Score

Score instructions: One point is assigned for each question answered as yes. The score is calculated by adding all points (total score range, 0–17). For “Doctor visits last year,” one point is assigned for ≥3 visits, and one more point (two total) if the patient also had ≥6 visits. Reproduced with permission from Forno et al., Chest 2010 ⁽²³⁾.