Preventable Factors in Fatal and Near-Fatal Asthma: Lessons From the British Thoracic Society (BTS) and the National Review of Asthma Deaths (NRAD).

Asthma is one of the most widespread chronic respiratory illnesses that is still a leading cause of high morbidity and mortality even in the context of effective therapies and evidence-based clinical practice. The British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) provides a structured guideline on the management of asthma, and the National Review of Asthma Deaths (NRAD) has outlined the most significant gaps in routine asthma care that lead to preventable deaths. The purpose of the review is to consider the preventable aspects related to fatal and near-fatal asthma and to comment on the major learning points from the BTS/SIGN asthma guidelines and the results of the NRAD. A narrative database literature review was carried out using PubMed, Scopus, and Google Scholar to obtain relevant peer-reviewed literature published since 2005 till December 2025. Search words were fatal asthma, near-fatal asthma, asthma mortality, preventable factors, NRAD, and the BTS asthma guideline. Articles on asthma mortality, severe exacerbations, and asthma management using the guidelines were selected. The literature recognizes various preventable causes of fatal and near-fatal asthma; among them are poor adherence to inhaled corticosteroid treatment, overuse of short-acting β2-agonists (SABA), the presence of poor follow-up following an asthma attack, absence of individualized asthma action plans, and failure to recognize worsening symptoms. Findings in the NRAD research also indicated the shortcomings of standard check-ups of asthma, minimal use of controller drugs, and the inability to recognize at-risk patients as the key contributors to asthma death. It is possible to prevent many asthma deaths by increasing observance of guidelines, early recognition of high-risk patients, and providing them with more education and self-management support. Strengthening the implementation of the BTS/SIGN guidelines and addressing gaps in NRAD insights could be key to improving the quality of asthma care and preventing asthma-related deaths.