Asthma and life insurance

Usually a non-event

Asthma is one of the most common chronic conditions in Canada. For most people who have it, it is also one of the conditions that matters least in life insurance underwriting.

Take mild asthma controlled with an inhaler used now and then, with no emergency visits and no hospital stays. That typically results in standard rates. Many applicants with this history see no effect on their price at all.

The assessment becomes more careful as severity rises. Severe, poorly controlled asthma is truly assessed as a significant condition. The distance between those two ends is wide.

How underwriters gauge severity

They cannot measure how your chest feels. They work from countable things in the record.

Frequency of symptoms. How often you use a reliever inhaler, whether symptoms wake you at night, and whether they limit activity.

Treatment required for control. A reliever used now and then sits at one end. Regular inhaled controller medication is ordinary and unremarkable. Several controller medications, or biologic therapy for severe asthma, point to a condition that needs a lot of management.

Courses of oral steroids. This is the item underwriters count most closely. Prednisone courses mark exacerbations, or flare-ups, that were serious enough to need systemic treatment. Systemic means the treatment works through the whole body. Their number and how recent they were are among the most telling things in an asthma file.

Emergency visits and admissions. Visits to an emergency department for asthma, and any hospital admission. Any stay that needed intensive care or ventilation counts most. An intensive care admission for asthma is a serious marker even if it was years ago.

Time off work or school. Where recorded.

Picture a file with regular controller use, no steroid courses and no emergency visits over several years. That describes well-controlled asthma, whatever the label on the diagnosis.

Childhood asthma

Very common, and it often causes needless worry on applications.

Asthma diagnosed in childhood that resolved, with no symptoms and no treatment for many years, is usually a footnote. Underwriters see it constantly, and it rarely affects anything.

It still needs disclosing. Applications ask whether you have ever been diagnosed with or treated for a respiratory condition. The correct answer is yes, with the detail that it resolved. Say when it stopped and when you last needed treatment.

Adult-onset asthma is looked at somewhat more carefully than childhood asthma that carried on. That is mainly because underwriters want to understand what prompted it.

Smoking changes everything

This is the most important interaction on the page.

Asthma alongside nicotine use is assessed far more seriously than either factor alone. Smoking worsens asthma control. It speeds up the decline in lung function. It also blurs the line with chronic obstructive pulmonary disease (COPD).

Take an applicant with moderate asthma who does not smoke, and another with the same asthma who does. In underwriting terms, they are not close to each other. The combination often drives a rating where the asthma alone would not have.

Cotinine testing, which detects nicotine in the body, is done at a paramedical. It makes current nicotine use visible regardless of what the application says. See smokers, vaping and nicotine testing.

Where asthma and COPD meet

Some people have features of both. This is most common in those with a long smoking history and long-standing asthma. Where records describe overlapping features, underwriters usually assess on the more serious of the two. That usually means the assessment described in COPD and emphysema.

If your records use a mixed description, expect an underwriter to want the specialist’s view of what is really going on.

Applying

Have the details:

• When you were diagnosed.
• What you take, and how often.
• Roughly how often you use a reliever.
• Whether you have needed oral steroids, and when.
• Whether you have visited emergency or been admitted.

For childhood asthma that resolved, the useful information is when it stopped and when you last used any treatment.

Most asthma applications are straightforward. The ones that need care are those with recent steroid courses, recent emergency visits, or asthma alongside smoking. Those are worth placing with care rather than sending to a single insurer.

The boundary

This page describes how insurers read a file. It is not information about asthma or its management. Nothing here is a suggestion about inhalers, medication or treatment. Your doctor owns all of that.