Wheezing and dyspnea predict exacerbations in mild asthma

Published online April 25, 2025

Asthma is often perceived as a mild, manageable condition, but nearly one-third of patients with mild asthma experience symptoms that are not well controlled and can lead to acute asthma exacerbations (AAEs). While prior studies have examined risk factors for AAEs, little is known about how common asthma symptoms, especially in mild asthma, relate to future exacerbation risk. 

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Chen and colleagues leveraged natural language processing (NLP) to extract asthma symptoms from unstructured clinical notes and patient-provider communications in the EHRs of nearly 200,000 adults with mild asthma enrolled in Kaiser Permanente Southern California. Mild asthma was defined by low healthcare utilization and minimal medication use. The study evaluated the prevalence of key symptoms, including wheezing, cough, dyspnea, and chest tightness, and their association with future AAEs.

By using validated NLP algorithms, the researchers were able to identify symptom documentation that is typically not captured through structured diagnostic codes. The study included a comprehensive analysis of demographics, comorbidities, medication use, and other potential confounders to isolate the predictive impact of symptoms on future exacerbation risk. This novel approach highlights the potential of NLP to enrich clinical understanding of disease burden in populations that often go under-assessed.

Of the 198,873 patients studied, 6.5% experienced an AAE within a year of their index visit. While all four symptoms were associated with increased exacerbation risk in unadjusted models, only wheezing and dyspnea remained significant risk factors after controlling for patient demographics and clinical characteristics. Patients with documented wheezing had a 13% higher risk (adjusted relative risk [aRR] 1.13), and those with dyspnea had a 17% higher risk (aRR 1.17) of AAE. The risk increased further with greater symptom frequency, especially when both symptoms were present. These findings suggest that wheezing and dyspnea in mild asthma patients are clinically meaningful indicators of future exacerbation risk.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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