Predicting and reducing risk of exacerbations in children with asthma in the primary care setting: current perspectives.

Childhood asthma is a very common condition in western countries and is becoming more prevalent worldwide. Asthma attacks (or exacerbations) affect the quality of life for child and parent, can rarely result in death, and also come at a cost for health care providers and the economy. The aims of this review were to 1) describe the burden of asthma exacerbations, 2) describe factors that might predict a child at increased risk of having an asthma attack, and 3) explore what interventions might be delivered in primary care to reduce the risk of a child having an asthma attack. Asthma attacks are more common in younger children and those with more severe asthma, although prevalence varies between countries. Many factors are associated with asthma attacks including environmental exposures, patient-clinician relationship, and patient factors. Currently, the best predictor of an asthma attack is a history of an attack in the previous 12 months, and the more attacks, the greater the risk. Looking ahead, it is likely that surveillance of routinely collected primary care data can be used to identify an individual at increased risk. Stratified (or personalized) treatment, which might involve physiological monitoring and genetic analysis, offers the potential to reduce an individual's risk of asthma attack. Whatever the future holds, the relationship between patient and clinician will remain central to asthma management.