Prognosis

In 2021, 1146 deaths were registered in England and Wales where the underlying cause was recorded as asthma.[69]​ In the US, about 5000 deaths per year are attributed to asthma, and most of these deaths are preventable with treatment.[70] The prognosis for an exacerbation is good with prompt recognition of symptoms and access to care.

Patients with poorly controlled asthma are at risk for developing long-term airway changes over time that may become irreversible. Severe exacerbations are associated with a greater long-term decline in lung function in patients who are not taking inhaled corticosteroids (ICS) compared to those using ICS.[1]​ However, there is no clear evidence that ICS treatment prevents the development of persistent airflow limitation.[1]

British Thoracic Society (BTS) guidelines highlight an increased risk of near-fatal or fatal asthma in patients with severe asthma and one or more adverse behavioural or psychosocial features (e.g., failure to attend appointments, non-adherence with treatment/monitoring, psychiatric illness, learning difficulties, alcohol or drug abuse, employment/income issues, social isolation, severe domestic/legal stress).[13]​ The Global Initiative for Asthma (GINA) also identifies risk factors for asthma-related death:[1]

  • A history of near-fatal asthma requiring intubation and mechanical ventilation

  • Hospitalisation or emergency care visit for asthma in the past year

  • Currently using or having recently stopped oral corticosteroids

  • Not currently using ICS

  • Over-use of short-acting beta-2 agonists, especially use of one or more inhalers of salbutamol (or equivalent) monthly on average, or use of nebulised short-acting beta-2 agonist

  • Poor adherence to ICS-containing medications and/or poor adherence to (or lack of) a written asthma action plan

  • A history of psychiatric disease or psychosocial problems

  • Food allergy (or anaphylaxis) in a patient with asthma

  • Certain comorbidities including pneumonia, diabetes, and arrhythmias

The use of inhaled corticosteroids has been shown in several studies to decrease hospital admission and mortality rates.[71][72]

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