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Risk factors for asthma exacerbations
Lauri Nordman1, Iida Vähätalo1,2, Leena E Tuomisto1,2
1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
The Journal of Allergy and Clinical Immunology. Global
|July 23, 2025
Summary
Adult-onset asthma patients frequently have multiple exacerbation risk factors, with poor adherence, chronic rhinosinusitis, and smoking being most common. Gastroesophageal reflux disease is a significant predictor of asthma exacerbations in this population.
Area of Science:
- Pulmonology
- Clinical Medicine
- Epidemiology
Background:
- Adult-onset asthma presents complex challenges, often involving comorbidities.
- Prevalence of exacerbation risk factors in adult-onset asthma remains understudied.
- Global Initiative for Asthma (GINA) guidelines emphasize evaluating exacerbation risk factors.
Purpose of the Study:
- To determine the prevalence of exacerbation risk factors in adult-onset asthma.
- To assess the association between these risk factors and asthma exacerbations.
- To evaluate risk factors based on the 2023 GINA Report.
Main Methods:
- A 12-year follow-up of 203 adult-onset asthma patients (Seinäjoki Adult Asthma Study).
- Analysis of 17 out of 21 GINA-defined risk factors.
- Exacerbations defined as unplanned healthcare visits for asthma.
Main Results:
- Patients averaged 3.8 exacerbation risk factors; common factors included poor adherence (54.7%), chronic rhinosinusitis (54.2%), and smoking (52.7%).
- Gastroesophageal reflux disease (GERD) and age >50 were associated with exacerbations in univariate analysis.
- After adjustment, only GERD remained a significant risk factor (OR, 4.5; 95% CI, 1.5-14.0; P = .009).
Conclusions:
- Exacerbation risk factors are prevalent in adult-onset asthma.
- Identifying single risk factors may have limited clinical value.
- Focusing on patients with multiple risk factors and/or GERD is crucial for clinical practice.
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