Box 9.4.

Assessment of future risk of adverse outcomes of asthma in children*

Risk factors	Assessment
Asthma attacks within the next few months	Uncontrolled asthma symptoms One or more severe asthma attacks in the previous year The start of the child’s usual “flare-up” season (especially if autumn/fall) Exposures: Tobacco smoke; indoor or outdoor air pollution; indoor allergens, especially in combination with viral infection Major psychological or socioeconomic problems for child or family Poor adherence manifested as underuse of ICS and/or over-use of SABAs
Fixed airflow limitation	Severe asthma with several hospitalizations History of bronchiolitis
Medication side effects	Systemic: Frequent courses of oral corticosteroids or high-dose ICS; neuropsychiatric adverse reactions after the initiation of LTRA Local: Moderate/high-dose or potent ICS; incorrect inhaler technique; failure to protect skin or eyes when using ICS by nebulizer or spacer with face mask

ICS: Inhaled corticosteroid, LTRA: Leukotriene receptor antagonist, SABA: Short-acting bronchodilator