Risk Factors for a Serious Asthma Episode

In the very worst-case scenarios, asthma can be deadly. In Michigan, 321 people have died from asthma between 2015 and 2017. Asthma deaths are very tragic because they can be prevented with the proper treatment and education.

A person should never underestimate the severity of an asthma attack. Even people with mild asthma are at risk for severe and even fatal attacks. There are certain risk factors that suggest a person with asthma needs to be particularly careful because their asthma is not under control.

• Previous severe asthma attack
• Two or more hospital stays due to asthma or 3 or more ED visits in the past year
• Use of 2 refills of your quick relief medication per month
• Difficulty in sensing an oncoming asthma attack. You feel “surprised” by your asthma attacks
• Inner City Residence or low income levels
• Illegal Drug Use
• Comorbid conditions
• Major mental illness

No matter what your level of asthma control is, making an asthma action plan and following it is the first step in preventing an asthma emergency. Other steps you can take to manage an asthma exacerbation are:

• Use a written asthma action plan
• Recognize the early indicator of an exacerbation. View a list of warning signs for asthma.
• Adjust your medications
• Remove or withdraw allergens and irritants in the environment such as pets, cigarette smoke, and cleaning up spill.
• Monitor your symptoms and keep your doctor informed.

Asthma Mortality in Michigan

Michigan State University in partnership with the Michigan Department of Health & Human Services convened a panel of experts to discuss asthma deaths in Michigan and provide recommendations. They suggested:

• Case Management for high-risk patients (patients with an ED visit and/or a hospitalization for asthma). This includes case management for children with asthma where lack of adequate parental supervision is a problem and adults with psychiatric problems.
• Pharmacy notification to doctors for patients who repeatedly fill quick relief prescriptions and/or do not fill inhaled corticosteroids or other controller medication prescriptions for inhaled steroids. Also possibly placing a limitation on the number of ß-agonist refills allowed without a new prescription.
• Emphasis on the chronic and potentially severe nature of asthma and the importance of prescription and use of inhaled steroids to health care providers in all sectors (primary and urgent care) and among people with asthma.
• Provision of more comprehensive asthma care in the ED setting, including prescription of inhaled steroids at discharge and a system for connecting patients with a primary care provider for follow-up.
• Education for people with asthma in self-management, emphasizing the importance of adhering to inhaled steroid medication as prescribed.
• Referral to specialists for patients with a hospitalization and/or ED visit for asthma.
• Need for health insurance including coverage of medication costs for adults with asthma (not a problem in children).

Read the entire Mortality report (scroll down to Past Surveillance Initiatives).

Continuing Medical Education Credits (CMEs) are available online for many asthma topics, including asthma mortality.

You should never try these home management techniques because they have not been proven to be effective and can be very dangerous.

• Drinking large volumes of liquids
• Breathing warm, moist air
• Using over the counter products such as antihistamines or cold remedies.

Adapted from the Guidelines for the Diagnosis and Management of Asthma, National Asthma Education and Prevention Program, National Institutes of Health, 2007