The Diagnosis of Potentially Fatal Asthma

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Abstract:

The concept of life-threatening asthma is not new. Reviews of fatal asthma often describe retrospectively identified factors that were associated with or contributed to the patient's demise. We report 55 patients considered to have the diagnosis of potentially fatal asthma who were managed for 4.8 ± 4.3 years per patient. The diagnostic criteria of potentially fatal asthma included at least one of the following four potentially fatal asthma events: 1) mechanical ventilation for respiratory arrest or failure, 2) acute respiratory acidosis that did not necessitate mechanical ventilation, 3) two episodes of acute pneumomediastinum or pneumothorax associated with status asthmaticus, 4) two or more hospitalizations for status asthmaticus in spite of long term oral corticosteroids. The mean age of patients with potentially fatal asthma was 39.6 ± 19.1 (range 8.5–79.5 years). During 262 patient years of management, one 79 year old demented patient died from disseminated cryptococcal infection. Two patients died from asthma after leaving our service, one patient having left the hospital against medical advice with arterial blood gases demonstrating acute respiratory acidosis during status asthmaticus. Fifty-two patients are alive and ambulatory. Long-term corticosteroids have been essential in 43 of 45 patients in this series currently managed by full-time faculty of the Northwestern University Allergy Service. Complicating psychosocial factors of some patients with potentially fatal asthma include schizophrenia, bipolar disorders, denial of disease, adolescent non-compliance, and parental interference with essential medications for children. We believe that the diagnosis of potentially fatal asthma should be made following occurrence of major asthma events that place the patient at high risk for a death from asthma.

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/108854188778994968

Publication date: March 1, 1988

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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