Machine Learning Models for Early Prediction of
Asthma Attacks Based on Bio-signals and
Environmental Triggers
Abstract—Asthma is a common respiratory disease affected by
different bio-signals and environmental triggers. Early prediction
of asthma attacks is crucial to saving a patient’s life. Several
machine learning models have been designed to predict asthma
attacks. However, few models have exploited bio-signals and en-
vironmental triggers to build an asthma attack prediction model.
Additionally, little attention has been devoted to feature selection
algorithms and the variation of machine learning models. This
study develops an asthma attack prediction model by testing
different machine learning classifiers. The used dataset includes
two main parts; the bio-signals dataset, which is recorded daily
from 21 volunteers for three months, and the environmental
dataset, which is available online. The utilized machine learning
classifiers are support vector machine, logistic regression, decision
tree, random forest, and gradient boosting model. Each classifier
was grid searched to find the best value for the primary hyper-
parameters, then we used five-fold cross-validation to train each
model. Results show that the gradient boost model outperforms
the other classifiers when training it with 0.5 for the depth
parameter and 9 for the sub-sample parameter. The prediction
of the testing set produces 97.2% accuracy and 97.1% recall.
Index Terms—Asthma attack, Bio-signals, Environmental, Pre-
diction, Machine learning.
I. I NTRODUCTION
Asthma is one of the most prevalent inflammatory diseases
that can affect anyone at any age [1]. Many researchers inves-
tigated the causes and risk factors of asthma and the likelihood
of having an asthma attack. Bio-signals and environmental
triggers were classified as risk triggers [2], [3]. The bio-
signals are related to the patient’s health, including allergies,
symptoms, and medical history. Any external stimulus, such
as weather and air pollution, is considered an environmental
trigger. Air Quality Index (AQI) is generally used to assess
air pollution’s overall state, which is calculated using the
concentrations of existing air contaminants. Asthmatic people
may experience health concerns if the AQI exceeds 51 [4].
Early prediction of asthma attacks is essential for enhancing
the patient’s quality of life. Artificial intelligence (AI) has a
sub-field called machine learning (ML) that uses algorithms
to predict outcomes using a large amount of disease-related
data [5]. Asthma attack prediction models based on machine
learning approaches have been proposed in recent publications.
Most of these studies [6]–[8] used bio-signals as triggers for
predicting asthma attacks. Others [9]–[14] used weather and
AQI to predict asthma attacks without considering the bio-
signals triggers. Modern models should recognize individuals’
bio-signals and environmental triggers, which are required for
a reliable asthma attack prediction model. We discovered that
few models had used bio-signals and environmental triggers
to predict asthma attacks [15]–[17]. In addition, less consid-
eration has been paid to feature selection algorithms and the
variation of machine learning models.
To fill this gap, this study uses both bio-signals and
environmental triggers to create an effective asthma attack
prediction model. This study aims to find an optimum classifier
for asthma attack prediction. Five different classifiers are
compared regarding the accuracy and recall metrics. These
classifiers are support vector machine (SVM), logistic regres-
sion (LR), decision Tree (DT), Random Forest (RF), and
Gradient Boost Model (GBM). Besides, the L1-based feature
selection algorithm is applied with these techniques to provide
more accurate models. In addition, this study introduces a new
asthma dataset that includes many bio-signal and environmen-
tal triggers.
The structure of this article is as follows. The related work is
introduced in Section II. The study’s methodology is explained
in Section III. The findings of all classifiers are introduced in
Section IV. Section V introduces the conclusion and future
research.
II. R ELATED W ORK
Recent studies utilized different triggers and classifiers to
build a prediction model for asthma attacks. Finkelstein and
Jeong [7], [8] developed a model that predicts asthma attacks
by utilizing multiple bio-signals triggers without considering
the environmental triggers. Their first study [7] study included
a comparison of different machine learning classifiers, which
are SVM, naive Bayesian (NB), and adaptive Bayesian net-
work. The outcomes demonstrated that the ABN classifier
had greater specificity and sensitivity (100 %) than other
classifiers. Their second study [8] developed a prediction
model for asthma exacerbation using the Classification and
Regression Tree (CART) algorithm. The model predicts the
asthma for the upcoming day whether it could be normal or
abnormal. The final model achieved 80 % accuracy, 64 %
sensitivity, and 97 % specificity.
Another study by Lee et al. [15] demonstrated how ap-
plying several predictors from various sources can improve
the model’s performance. Thirty-seven attributes were used,
including multiple bio-signals and environmental triggers. The
utilized ML algorithms were Pattern-Based Class-Association
Rule (PBCAR) and Pattern-Based Decision Tree (PBDT).
According to the model’s performance, asthma attacks may be
predicted with an accuracy of 0.87. With an accuracy of 87 %
and 86 %, respectively, the experimental results demonstrate
that PBDT performs somewhat better than PBCAR.
Kaffash-Charandabi et al. [16] developed another prediction
model for asthma attacks. They used a dataset that includes
bio-signals data obtained from three participants in addition to
the environmental triggers. The SVM algorithm was used, and
the model’s accuracy was 93 %. However, it is uncertain how
well the model would perform if tested on a more significant
population because it was only trained and tested on three
people.
Khasha et al. [17] conducted another comparison between
five different classifiers: RF, DT, SVM, LR, and GBM. The
decision tree classifier outperformed all other classifiers. These
classifiers’ performance was not accurately reflected. Only
figures, however, were utilized to convey the results.
Hosseini et al. [18] proposed another model that utilizes
only two bio-signals triggers with AQI. They used the RF
classifier and 10-fold cross-validation to categorize the like-
lihood of experiencing an asthma risk into low, medium, or
high risk. The suggested model achieved an accuracy of 80%.
According to these studies, there is a lack of utilizing
both bio-signal and environmental triggers in building asthma
attack prediction models. Adding extra triggers as features
significantly improves model performance, as seen in [15].
Also, none of the related works utilized any of the feature
selection algorithms, which may provide better model perfor-
mance. Table. I provides a summary of the related work with
their limitations. In this paper, multiple triggers are considered
besides the application of an additional feature selection stage.
We compare different machine learning classifiers to build
an effective asthma attack prediction model since different
classifiers produce different results.
III. R ESEARCH M ETHODOLOGY
The research methodology includes three main stages. The
first stage consists of generating and preparing an integrated
dataset that includes both bio-signals and environmental trig-
gers. The second stage uses the L1-based feature selection
algorithm, which helps find the best feature set that contributes
to the model. Then, the selected feature set is used to train the
model through the five selected classifiers using grid search
and 5-fold cross-validation to find the average accuracy and
recall. The third stage is selecting the best-trained model and
testing it to find the final prediction results. Fig. 1 shows
the study methodology in the form of a schematic flow
chart to facilitate the reader’s understanding. The following
subsections explain each stage in detail.
A. Stage 1: Data generation and preparation
The dataset used in this study integrates both patients bio-
signal data and environmental factors. The bio-signal data was
collected though Google Forms. It involves 21 volunteers older
than 12 years and having different levels of asthma disease
(mild, moderate, and severe). The dataset has two main parts:
historical and daily records. The historical data consist of the
patient’s’ diagnostic data for the previous four weeks and the
daily records include asthma symptoms that were recorded for
next three months (from 24-march – 30-June 2021). Most of
the collected data is categorical and is based on a scale of five:
never, rarely, sometimes, often, and always. The environmental
data was collected online [19]. It includes weather variables
and AQI. The two datasets were then integrated based on
patients’ locations and the date.
The integrated dataset includes 655 entries with various
bio-signals and environmental features as shown in Table II.
The target is whether the use had an asthma attack (class
1) or no (class 0). The data was cleaned by replacing the
missing values with the means then standard normalization
was used to generate the final dataset. The integrated dataset
was imbalanced since the ratio between the class 0 and class
1 is 7:58. To solve this issue, the Synthetic Minority Over-
sampling Technique using Support Vector Machine (SMOTE-
SVM) [20] was applied to reach a balanced dataset with a
ratio of 1:1.
B. Stage 2: Feature Selection and Classifiers Training
Feature selection reduces the dataset’s dimensionality by
deleting irrelevant and unnecessary features from the original
dataset [21]. The remaining features are fed into the prediction
model as input. This pre-processing stage can improve the
classification accuracy of the prediction model.
LASSO Regularization (L1) [22] is one of the most common
feature selection algorithms. It applies a penalty to the various
machine learning model parameters to prevent over-fitting.
The penalty is applied over the coefficients that multiply
each feature in a linear model regularization. Some of the
coefficients from the various forms of regularization can be
shrunk to zero using the Lasso or L1 technique. As a result,
the model can be trained without that feature.
This work applies the L1 algorithm to the integrated dataset
to reduce the set of features. The resulting dataset is split into
training and testing sets with the ratio 80:20. The data was then
trained with 5 classifiers: SVM, LR, DT, RF, and GBM. Grid
search was used to tune hyper-parameters thus increasing the
classifier performance. We provide in what follows a quick
overview on each classifier and the tuned hyper-parameters
with the searched values.
• Decision Tree (DT) builds incrementally a classification
model as a tree composed of a root, internal and leaf
nodes. It classifies instances by sorting them from the
tree’s root to a leaf node based on a given criterion [23].
The most important parameters tuned in DTs are the tree
depth and the split criterion. We used different depth
values (2,4,6,8,10,12) and two main criteria in the grid
search, gini and entropy.
• Random Forest (RF) is an ensemble machine learning
approach that fits a number of decision tree classifiers on
various dataset sub-samples. It use the average to raise
prediction accuracy and reduce over-fitting [24]. Usually,
each tree is built using a subset of the dataset based on
 TABLE I
S UMMARY OF RELATED WORK MODELS WITH THEIR LIMITATIONS

Reference Utilized Triggers ML classifiers Performance Limitations

[7] Bio-signals NB, ABN, and SVM ABN (best) sensitivity: 100 % Did not used environmental trig-
specificity: 100 % gers.
[8] CART Specificity: 97 %, Sensitivity: 64 Did not used environmental trig-
%, Accuracy: 80 %. gers and has low accuracy.
[15] Bio-signals and environmental. PBDT, and PBCAR PBDT (best) Accuracy: 87 % Accuracy is low and the recall
was not specified.
[16] Bio-signals and environmental. SVM Accuracy: 93 % Participants were limited to three
only.
[17] Bio-signals and environmental. RF, DT, SVM, LR, and GBM. Not specified The performance of models was
not specified in numerical val-
ues.
[18] Bio-signals and environmental. RF Accuracy: 80 % Few utilized triggers.

Fig. 1. The proposed asthma attack prediction model.

 TABLE II
L IST OF DATASET FEATURES
Category Features
Patients’ diagnostic record family members with asthma, family mem-
bers with allergies, controlling asthma dur-
ing last four weeks, existence of chronic
disease other than asthma, allergies, smok-
ing status, normal PEFR, sleep disturbances
during last four weeks, cough during last
four weeks, chest tightness during last four
weeks, use of asthma medication during last
four weeks, physician visits during last four
weeks, work ability during last four weeks,
and number of asthma attacks during last
four weeks.
Daily asthma symptoms Cough, chest tightness, sleep disturbances,
work ability, breath difficulty, chest tight-
ness, self-smoking or surrounding smoke,
medication usage, exposure to external trig-
gers, exposure to internal triggers, exposure
to bio-signals triggers, PEFR reading, and
PEFR label.
Environmental Dataset Weather Temperature, relative humidity,
wind speed.
Air pollution AQI
Target Asthma attack
the subsamples value. The used parameters in the grid
search are max-sample and max-features. The sub-sample
determines the size of the subset given to the individual
tree. The used values were (10, 100, and 1000). The max-
features resemble the features provided to each tree in RF.
The used options were sqrt and log2.
• Gradient Boosting Model (GBM) is an ensemble machine
learning approach for classification and regression [25].
It uses a combination of weak prediction models, often
DTs to build a stronger prediction model. It updates the
predictions using a loss function, such as mean squared
error (MSE), so that the sum of the residuals is relatively
close to zero (or minimal), and the projected values are
sufficiently similar to the actual values. GBM model
was grid searched to find the best maximum depth that
indicates how deep the tree can be and sub-sample that
sets the fraction of samples to fit each base learner. The
tested values of max depth and sub-sample are (3,7,9,11)
and (0.5,0.7,1), respectively.
• Logistic Regression (LR) is a method that predicts the
target variable (dependent) by analyzing the relationship
between multiple independent variables [26]. The output
of this method is the probability, representing the obser-
vation categories. We used two main parameters in the
grid search to tune the LR model. These parameters are
the solvers and C. The solvers are the algorithms that
can be used in the optimization problem, and C is the
inverse of the regularization strength. The used solvers
were (newton-cg, lbfgs, and liblinear) and C values were
(0.01,0.1,1,10,100).
• Support Vector Machine (SVM) works by deriving sup-
port vectors from a portion of training data. The support
vectors are the examples that are most likely to be
found at the maximum margin hyperplane, which offers
the greatest separation between the classes [27]. The
support vectors are generated by using limited quadratic
optimization. Due to the maximum margin hyperplane’s
relative stability, even in the high-dimensional space
spanned by nonlinear transformations, support vector
machines are advantageous in situations with nonlinear
class borders and avoid the overfitting issue. The most
parameters that play a significant role in SVM are C and
the kernel, which transforms the data into different forms.
We performed a grid search for different C values (0.1,
1,10,100,1000) and the main kernels (radial basis function
(RBF), Polynomial, Sigmoid, and Linear).
Each of these classifiers is trained with two datasets; the
original data with all features and the L1-based selected
features. The training process uses 5-fold cross-validation to
get more information about their performance.
C. Stage3: Testing
After getting the best parameters for each prediction model,
they were tested using 5-fold cross-validation. The perfor-
mance was measured using accuracy, recall, and area under
the curve (AUC-ROC) metrics. The accuracy shows how the
model generally produces an accurate result. Whereas recall
is the most crucial metric in any healthcare model as it
measures the model’s ability to identify actual positive cases.
Recall close to 1.00 implies that model’s ability to discover
all patients who have the disease. The area under the curve
(AUC-ROC) is another essential metric which summarizes
the area under the precision-recall curve as an integral or an
approximation. AUC close to 1.0 indicates a high level of
separability in a good model. The accuracy and recall were
the primary metrics to compare all the classifiers. The best
results indicate the best model.
IV. R ESULTS AND D ISCUSSION
This study was designed to build an accurate asthma attack
prediction model using multiple bio-signals and environmental
triggers.
The original dataset had 30 features; 26 bio-signals, three
weather, and one air pollution. L1-based feature selection has
been utilized to find the features contributing to the model
performance and eliminate unnecessary features. The remain-
ing features after L1-based feature selection are 22 features.
The eliminated features are: family members with allergies,
last four weeks physician visits, last four weeks work ability,
existence of chronic disease other than asthma, exposure to
external triggers, PEFR percentage, visiting physician, and
wind speed.
Both the original dataset and the L1-based selected dataset
were used to evaluate the performance of DT, RF, GBM, LR,
and SVM classification models. Each of these classifiers was
grid searched with the most important parameters to find the
best values that fit the model and improve its performance. The
results of the grid search provide us with optimized parameters
which used to save the best models and then test them with the
test set. The model’s performance was measured by calculating
the model’s accuracy and recall.
The grid search for the DT classifier using the original
dataset provides the best recall with a depth of 10 and the
entropy as a split criterion, see Fig. 2(a). The recall of DT
using the L1-based dataset is increased slightly using the Gini
criterion and depth of 12, see Fig. 2(b). The mean accuracy
of the five-fold cross-validation using the L1-based dataset is
88 % , and the mean recall is 89 %. The accuracy and recall
of the testing test are 89 %.
The best parameters for RF are max-samples of 100 and
max-features of log2, see Fig. 3(a). The L1-based dataset
increased the model recall significantly using the same pa-
rameters, see Fig. 3(b). The mean accuracy of the five-fold
cross-validation using the L1-based dataset is 91 %, and the
recall is 92 %. Testing results show the model’s ability to
predict unseen data with 92 % accuracy and 93 % recall.
The grid search of the LR classifier produced the best
performance by using the value 10 for the C parameter, giving
the same results for all kinds of solvers, see Fig. 4(a). However,
the remaining CV results show a recall between 90 and 94 %
using the original dataset. The cross-validation results show
the recall is between 92.4 and 93.5 %, which demonstrates
an improvement of the model performance, see Fig. 4(b). The
mean accuracy of the five-fold cross-validation using the L1-
based dataset is 94.3 %, and the recall is 93 %. Testing results
reveal the model’s ability to predict unseen data with 94 %
accuracy and 95 % recall.
The GBM exhibits the best results compared to other
classifiers. The optimized parameters for the trained models
using the original dataset are 0.5 for depth, and 9 for sub-
sample, see Fig. 5(a). Using the same depth and sub-sample 11
with the L1-based dataset generates increased model recall, see
Fig. 5(b). The mean accuracy of the five-fold cross-validation
is 97 %, and the recall is 98 %. Testing results show the
model’s ability to predict unseen data with 97 % accuracy
and 98 % recall.
The grid search result shows that SVM can work better
with the polynomial kernel and C = 0.1 using the original
dataset, see Fig. 6(a). The same parameters were used with
the L1-based dataset, and the recall increased significantly,
see Fig. 6(b). The mean accuracy and recall of the five-fold
cross-validation using the L1-based feature set is 91 %. Testing
results show the model’s ability to predict unseen data with 91
% accuracy and 92 % recall. The performance of all classifiers
using the original dataset is displayed in Table. III, and using
L1-based selected features is displayed in Table. IV. We can
see that the DT classifier has the lowest performance compared
to classifiers while GBM outperforms all other classifiers.
V. C ONCLUSION
This study produces a new dataset including patients’ di-
agnostic data and recorded daily bio-signals. This dataset is
coupled with the environmental data according to patients
locations to build an integrated dataset. An asthma attack pre-
diction model is conceived by comparing five machine learn-
ing classifiers: support vector machine, logistic regression,
decision tree, random forest, and gradient boost model. The
testing results demonstrate the gradient boost model achieves
the best prediction with the highest recall and accuracy,
97.2%and 97.1%, respectively. In future research, we plan to
use the created model to develop an application that helps
predict personalized asthma attacks dynamically by obtaining
the potential triggers in real-time using different sensors. Such
an application can alarm the users to survive sudden asthma
attacks.
ACKNOWLEDGMENT
The authors would like to express their special gratitude to
the volunteers, and the Ministry of Health in Makkah region
research center, who agreed to this research and helped us
collect the dataset.
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 Fig. 2. Grid search for DT model with their hyper-parameters using (a) all features (b) L1-based feature set

Fig. 3. Grid search for RF model with their hyper-parameters using (a) all features (b) L1-based feature set

Fig. 4. Grid search for LR model with their hyper-parameters using (a) all features (b) L1-based feature set

TABLE III
C OMPARISON OF THE ML CLASSIFIERS U SING A LL FEATURE SET

ML classifier Cross validation performance Test set performance

Accuracy Recall AUC-ROC Accuracy Recall AUC-ROC
Decision Tree 87 88 87 88 89 88
Random forest 88 87 88 90 91 90
Gradient boosting model 95 95 95 96 95 95
Logistic regression 92 93 92 93 93 93
Support vector machine 87 89 87 88 90 88
 Fig. 5. Grid search for GBM model with their hyper-parameters using (a) all features (b) L1-based feature set

Fig. 6. Grid search for SVM model with their hyper-parameters using (a) all features (b) L1-based feature set

TABLE IV
C OMPARISON OF THE ML CLASSIFIERS U SING L1- BASED SELECTED FEATURE SET

ML classifier Cross validation performance Test set performance

Accuracy Recall AUC-ROC Accuracy Recall AUC-ROC
Decision Tree 88 89 88 89 89 89
Random forest 91 92 91 92 93 92
Gradient boosting model 97 98 97 97 98 97
Logistic regression 93 93 93 94 95 94
Support vector machine 91 91 91 91 92 91