Primary prevention

Preventing asthma symptoms, exacerbations, accident and emergency department visits, or hospitalisations are key goals of asthma care that can be achieved through appropriate treatment and adherence.[7][51]​​​​ Assessment should consider both retrospective symptom control and the risk of exacerbations; symptom control alone is not an adequate measure.

The Global Initiative for Asthma (GINA) list the following as risk factors that should be assessed when evaluating exacerbation risk:[7]

  • A history of one or more exacerbation in the previous year

  • Short-acting beta-2 agonist (SABA)-only therapy without an inhaled corticosteroid (ICS)

  • SABA overuse

  • Socio-economic factors

  • Poor adherence

  • Incorrect inhaler technique

  • Low forced expiratory volume in 1 second (FEV₁)

  • Exposure to triggers, such as smoking

  • Elevated markers of type 2 inflammation (elevated blood eosinophil count, raised FeNO)

The following steps are recommended for patients who have poor symptom control, exacerbations despite treatment, or risk factors for future exacerbations:[7]

  • Check the patient’s inhaler technique and show them the correct technique

  • Discuss adherence to treatment and any barriers

  • Check that the patient has a written, personalised asthma action plan

  • Confirm the diagnosis of asthma, if there is any doubt

  • Remove or mitigate any risk factors or triggers, if possible

  • Manage comorbidities

  • Consider stepping up long-term treatment

  • Consider specialist referral.

Asthma action plans help parents and children to recognise when asthma is deteriorating and how to respond appropriately: for example, increasing usual reliever and maintenance treatment, starting a short course of oral corticosteroids, and determining when to seek medical help.[7] School‐based asthma self‐management interventions, engagement in the decision-making process, and even the use of digital interventions (e.g., trackers or reminders) may help.[52][53][54]​​​​​​[55]

Tailored allergen mitigation strategies may also be beneficial in individuals who are exposed to relevant allergens (e.g., dust mites or cat dander) and have a history of associated symptoms or positive allergy testing (e.g., skin testing or a specific IgE).[56] Multicomponent allergen interventions are recommended based on experience that single-component interventions often do not work.[56][57]​ 

See Asthma in children for more information about how to maintain control of asthma.

Secondary prevention

Check patients' adherence to treatment and inhaler technique, ensure patients have a written asthma action plan, consider specialist referral (including confirmation of the diagnosis of asthma), and review any persistent allergen exposure, triggers and comorbidities.[7]​ Patients who continue to experience asthma exacerbations despite treatment may need to have their treatment stepped up.

Viral infection and immunisation

Viral infections are a significant trigger for acute asthma exacerbations and may be prevented by vaccination.[7]​​ Vaccination schedules vary by location; consult local guidance for recommendations. UKHSA: complete routine immunisation schedule Opens in new window CDC: child and adolescent immunization schedule by age Opens in new window​​​

Risk reduction

Improving control of related comorbidities, such as allergic rhinitis, may be beneficial to asthma control.[161] Relapse rates after discharge are higher in those with atopy.[162]​ Interventions to decrease environmental tobacco smoke exposure have been shown to benefit children at high risk of asthma exacerbations.[163][164]​​ High efficiency particulate air (HEPA) filters reduce indoor air pollution and aeroallergens, improving asthma symptoms.[17]​ Public education campaigns appear to have positive effects on use or intention to use electronic nicotine delivery products.[28]

Oral corticosteroids

One Cochrane review showed that oral corticosteroids can reduce relapse rates, although this was based primarily on randomised controlled trials conducted in adults.[100] High-dose inhaled corticosteroid therapy has shown similar efficacy to oral corticosteroids, but is not as cost effective.[51]

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