A National Confidential Enquiry into Patient Outcome and Death report (NCEPOD) into 200 asthma deaths, most of which occurred out of hospital, found that the following were associated with an increased risk of developing near-fatal or fatal asthma:

A history of severe asthma

  • Previous near-fatal asthma (ventilation, ICU)
  • Previous admission for asthma in the last year
  • Requiring maintenance therapy of 3 or more classes of asthma medication
  • Heavy use of β2 agonist
  • Repeated ED attendances with asthma
  • ‘Brittle asthma’ (uncontrolled asthma despite maximum maintenance treatment or recurrent sudden severe episodes when asthma well controlled)

Presence of an adverse psychosocial factor

  • Non-compliance with treatment
  • Failure to attend appointments/ little GP contact
  • Frequent home visits
  • Denial
  • Self-discharge from hospital
  • Psychiatric illness, self harm, depression
  • Extreme situational stress (income/ employment/ marital/ legal)
  • Alcohol or drug abuse
  • Obesity
  • Learning difficulties
  • Social isolation
  • Childhood abuse

Admission should be considered for patients with a history of severe asthma and any adverse psychosocial factor regardless of the severity of the current episode.