1. Defining future risk in asthma Pt. II
John Blakey
Senior Clinical Lecturer, LSTM

2. Measure first – provide tailored solution

4. Figure reproduced with permission from Green et al
Figure reproduced with permission from Green et al. Lancet 2002;360:

5. Figure produced by Blakey JD
Figure produced by Blakey JD. A representation of a potential coordinates system to inform asthma management. Ongoing poor daily control results in escalation along the y axis and ongoing risk of severe asthma attack leads to escalation along the x axis. Letters represent example patients.

6. Pauwels RA et al. N Engl J Med 1997;337:1405-1411.

7. Omalizumab for treating severe persistent allergic asthma: NICE technology appraisal guidance (2013)
National Institute for Health and Care Excellence (2013). Omalizumab for treating severe persistent allergic asthma. NICE technology appraisal guidance (TA278).

8. Risk assessment tools

9. Asthma UK. Asthma attack risk checker. Available from https://www
Asthma UK. Asthma attack risk checker. Available from [Accessed Dec 2016].

10. Identifying risk of future asthma attacks using UK medical record data: a respiratory effectiveness group initiative
Blakey JD et al. J Allergy Clin Immunol Pract doi: /j.jaip
The Respiratory Effectiveness Group (REG). Future Asthma Risk (FAR) Calculator. Available from [Accessed Dec 2016].

11. JSB3 cardiovascular risk calculator
Joint British Societies for the prevention of cardiovascular disease. JBS3 Risk Calculator. Available from [Accessed Dec 2016].

12. Joint British Societies for the prevention of cardiovascular disease
Joint British Societies for the prevention of cardiovascular disease. JBS3 Risk Calculator. Available from [Accessed Dec 2016].

13. Common knowledge

14. “30% risk of snow”
Communicating risk

15. Figure reproduced with permission from Blakey J et al
Figure reproduced with permission from Blakey J et al. Prim Care Respir J 2013; 22(3):

16. e.g. weight loss e.g. new drug
Porter ME. N Engl J Med 2010; 363(26): Figure produced by Blakey JD.

18. β2−agonist use before hospital attendance
Figure reproduced from Patel M et al. NPJ Prim Care Respir Med 2015;25:14099, licensed under CC BY-NC-ND 4.0.

19. Reduce magnitude of loss

20. Intervene early >20% less likely to get OCS
Get them days later in the episode
2-3 x more likely to come back to the ED
More likely to report ongoing problems
2 week later
Both pregnant and non-pregnant women have 65% concordance with OCS bursts
Cydulka RK et al. Am J Respir Crit Care Med 1999;160: 887–92; McCallister JW et al. Respir Med. 2011;105(10):

21. National Center for Biotechnology Information (NCBI). https://www.ncbi.nlm.nih.gov/pubmed

22. Summary
New approaches are needed to activate people with asthma and guide therapeutic choices
Opportunities exist through newer technologies
There are significant gaps in evidence around routine practice