From the Guidelines
Risk factors for developing persistent asthma include early-onset asthma symptoms, severe or frequent asthma exacerbations, allergic sensitization to environmental allergens, exposure to tobacco smoke, family history of asthma or atopic diseases, obesity, female gender, and certain respiratory infections during childhood, as identified in the most recent study 1. These factors contribute to persistent asthma through various mechanisms including airway remodeling, chronic inflammation, and bronchial hyperresponsiveness. Key risk factors can be broken down into the following categories:
- Genetic and perinatal risk factors, such as family history of asthma or atopic diseases, and low birth weight or prematurity 1
- Environmental triggers, including exposure to tobacco smoke, air pollution, and occupational exposures to irritants or allergens 1
- Host factors, such as allergic sensitization to environmental allergens, obesity, and female gender 1
- Comorbid conditions, including allergic rhinitis, atopic dermatitis, or gastroesophageal reflux disease, which can increase the risk of persistent asthma 1 Early identification of these risk factors can help healthcare providers implement targeted interventions to potentially modify the disease course, including appropriate medication management, allergen avoidance strategies, and lifestyle modifications such as weight management and smoking cessation 1.
From the FDA Drug Label
The initiation of Wixela Inhub® in this setting is not appropriate Serious acute respiratory events, including fatalities, have been reported when salmeterol, a component of Wixela Inhub®, has been initiated in patients with significantly worsening or acutely deteriorating asthma. In most cases, these have occurred in patients with severe asthma (e.g., patients with a history of corticosteroid dependence, low pulmonary function, intubation, mechanical ventilation, frequent hospitalizations, previous life-threatening acute asthma exacerbations) and in some patients with acutely deteriorating asthma (e.g., patients with significantly increasing symptoms; increasing need for inhaled, short-acting beta2-agonists; decreasing response to usual medications; increasing need for systemic corticosteroids; recent emergency room visits; deteriorating lung function).
The risk factors for developing persistent asthma include:
- A history of corticosteroid dependence
- Low pulmonary function
- Intubation
- Mechanical ventilation
- Frequent hospitalizations
- Previous life-threatening acute asthma exacerbations
- Significantly increasing symptoms
- Increasing need for inhaled, short-acting beta2-agonists
- Decreasing response to usual medications
- Increasing need for systemic corticosteroids
- Recent emergency room visits
- Deteriorating lung function 2
From the Research
Risk Factors for Developing Persistent Asthma
The development of persistent asthma is influenced by a combination of genetic, environmental, and lifestyle factors. Some of the key risk factors include:
- Family history of asthma and allergies, which has been consistently shown to increase the risk of developing persistent asthma 3, 4, 5
- Maternal smoking during pregnancy, which has been linked to an increased risk of early-onset persistent asthma 3, 6
- Allergic sensitization, which is a strong predictor of asthma onset throughout childhood and into adulthood 6
- Low birthweight, severe respiratory infection, rhinoconjunctivitis, and eczema, which are associated with an increased risk of asthma onset in early childhood 6
- Breastfeeding for less than 3 months, which has been linked to an increased risk of asthma onset throughout the study period 6
- Exposure to environmental tobacco smoke, outdoor air pollutants, and increased pollen burdens, which can contribute to the development and exacerbation of asthma 7
Genetic and Environmental Interactions
The interaction between genetic and environmental factors plays a crucial role in the development of persistent asthma. For example:
- Family history of asthma and allergic diseases can increase the risk of persistent asthma, particularly in individuals with a strong family history 4
- Maternal smoking during pregnancy can interact with genetic predisposition to increase the risk of early-onset persistent asthma 3
- Exposure to environmental allergens and irritants can trigger the development of asthma in genetically predisposed individuals 7
Age-Specific Risk Factors
The risk factors for developing persistent asthma can vary depending on the age of onset. For example:
- Family history of asthma, allergic sensitization, and breastfeeding for less than 3 months are associated with asthma onset throughout childhood and into adulthood 6
- Low birthweight, maternal smoking during pregnancy, severe respiratory infection, rhinoconjunctivitis, and eczema are associated with asthma onset in early childhood 6
- The incidence of asthma is higher among boys until age 10 years, but from age 15 years, it becomes higher among girls 6