Can Asthma Attacks Be Predicted?

James Thompson, MD Health Pro
  • How often do you need to refill your reliever inhaler (ProAir, Ventolin, Proventil, Xopenex or Maxair)? Have you already required 2 or more refills since January? If so, you have an increased risk for an asthma attack. Clinical research has shown that people who require only one or two inhalers all year have fewer asthma attacks compared to those who require more. I know this seems like an obvious association since the more sick you are from asthma the more you will reach for the inhaler. But the point is doctors who provide medical care for asthma, and write prescriptions for asthma inhalers, may do a better job assessing asthma control if they monitor your reliever inhaler use.

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    Countless times patients have come into my office and when asked how they are doing, regarding asthma, they respond: “Doing fine”. Further questioning often reveals this is not the case. I think many people get too use to having a certain level of poor lung function. They don’t realize how bad they are breathing until they experience better breaths. Furthermore, they think daily use of reliever inhaler is not a bad thing, as long as it works. I want my patients to understand that needing their reliever inhaler more than twice a week, excluding exercise related puffs, reflects poor asthma control, even though it seems to work.

    The National Institute of Health (NIH) has published guidelines for asthma management which emphasizes the importance of assessing the frequency of chest symptoms and use of reliever inhalers. This allows your doctor to classify the severity level of asthma and appropriate level of treatment. This has previously been discussed by Rick Frea, one of the Health Pros for this site: Asthma Control vs. Asthma Severity.

    Tracking the number of reliever inhalers used over 6-12 month periods is not a metric found in the NIH guidelines although the expert panel does recognize the association with severity risk and assessment of control. A recent study highlights this concept of reliever refills and asthma attacks.

    A study published by Stanford and others in the Annals of Allergy Asthma and immunology analyzed the level of reliever inhaler use associated with increased asthma attacks. Over a hundred thousand adults and children were in the database for investigation. Data on reliever inhaler use was reviewed over a twelve month period. For children, use of three or more reliever inhalers annually best predicted future asthma attacks (flare-ups requiring hospitalization or ED visit). The chance of having an asthma attack was doubled if three or more reliever inhalers were required over the year. For adults, two or more reliever inhalers over a 3-6 month period predicted increased risk.


    Take Home Message:

    Help your asthma care provider assist you in improving asthma control by monitoring how often you need to use your reliever inhaler (times per day and per week). Realize if you need refills more than once every six months you should discuss whether changes or adjustments should be made in your controller medication. Have your inhaler technique reviewed by the doctor or nurse. Avoid missing doses of your controller medication (a common reason for subpar control). Discuss trigger factors and what you can do to reduce or eliminate them (environmental controls). Come back to this site and review previous and future postings about asthma.

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    I hope this article was helpful. I love helping people improve their asthma control. Although asthma can be life -threatening, it’s one of the most treatable chronic disorders.


    Can you think of some drawbacks in basing asthma control on the number of inhalers purchased over time?



    Stanford RH, Shah MB, O'Souza AO, et al: Short-acting β-agonist use and its ability to predict future asthma-related outcomes. Ann Allergy Asthma Immunol. 2012;109:403-407.

Published On: June 27, 2013