Risk Factors and Precipitating Triggers

Certain factors can increase the risk of experiencing an asthma exacerbation or trigger the onset of an acute event:

Risk Factors

• Poor adherence with controller medications like inhaled corticosteroids
• Inadequate asthma control or more severe persistent asthma
• Prior exacerbation in the past 12 months
• Comorbidities such as chronic sinusitis, obesity, or gastroesophageal reflux disease (GERD)
• Psychosocial factors like low socioeconomic status, urban residence, or mood disorders

Precipitating Triggers

• Viral upper respiratory infections (most common trigger in children)
• Allergen exposure:
  • Perennial allergens (dust mites, cockroaches, animal dander, mold)
  • Seasonal allergens (pollen)
• Irritants
  • Air pollution
  • Cigarette smoke
  • Strong odors or sprays
• Medications
  • Nonselective beta-blockers and NSAIDs can trigger bronchospasm
  • Abrupt discontinuation of inhaled corticosteroids

• Weather changes
• Exercise
• Stress or emotional upsets

Identifying and advising patients on strategies to avoid or minimize exposure to their unique triggers is a key responsibility of pharmacists. This includes optimizing controller regimens to prevent exacerbations and recommending allergen-specific immunotherapy in appropriate patients. Careful review of maintenance medications is also warranted to identify any potential precipitants.