Background Global Initiative for Asthma (GINA) advises to evaluate risk factors for exacerbations. Patients with adult-onset asthma often have a problematic disease presentation with comorbidities. Very little information exists on the prevalence of exacerbation risk factors presented by GINA in adult-onset asthma patients.

Aims and objectives To evaluate the prevalence of exacerbation risk factors listed in GINA Report 2022 and their association with exacerbations in patients with adult-onset asthma.

Methods In Seinäjoki Adult Asthma Study?a total of 203 patients with adult-onset asthma were followed for 12 years. Exacerbation risk factors were based on GINA. Data was available for 17 of the 21 risk factors. Exacerbation was defined as an unplanned visit for asthma and an oral corticosteroid (OCS) course or hospitalization.

Results On average, patients had 3.8 asthma exacerbation risk factors: poor adherence (54.7%), chronic rhinosinusitis (54.2%) and smoking (52.7%) being the most common. Four patients (2.0%) had none of the risk factors. OCS use and the number of exacerbations increased with higher risk factor scores. Exacerbations were positively associated with gastroesophageal reflux disease (GERD) (OR 5.0; 95%CI 1.7-15.1, p=0.004) and age ?50 years (OR 2.3; 95%CI 1.1-4.8, p=0.021) in univariate analyses. After adjustment for gender, pack-years and BMI, only GERD remained a statistically significant risk (OR 4.5; 95%CI 1.5-14.0, p=0.009) for exacerbations.

Conclusions Exacerbation risk factors are common in patients with adult-onset asthma, and the value of identifying a single risk factor may be low. Those with multiple risk factors and/or GERD should be recognized in clinical practice.