Malignant Potentially Fatal Asthma: A Management Strategy

The prevalence of asthma, asthma hospitalization rates, and asthma mortality are increasing in the United States. Criteria for corticosteroid-dependent asthma and potentially fatal asthma have been described. We report six patients with potentially fatal asthma whose disease became even more life threatening because of psychological, psychosocial, environmental, financial issues, or a combination of these factors. Two of these patients died of asthma. The single common denominator is that owing to a variety of factors these patients are noncompliant with medications, office visits, telephone instructions, or other points of management. Thus the term "malignant" in the context used in this report is to emphasize to patients and physicians that the asthma is unmanageable, not because of the asthma as a disease itself, but because the noncompliance of the patient makes the disease malignant. Patient education and confrontation regarding noncompliance did not reduce major asthma episodes. The patients place themselves at higher risk of death from asthma by not letting the physician help control their asthma. This poses a great dilemma to the physician, who must have the patients' health as the highest priority. A management strategy is outlined for these difficult patients.