Demographic characteristics of patients experiencing near-fatal and fatal asthma: results of a regional survey of 400 asthma specialists [see comment].

BACKGROUND

Case-control studies now describe a growing number of younger patients with varying levels of asthma severity who experience near-fatal or fatal asthma unexpectedly at home, en route to the hospital, or in public places.

OBJECTIVE

To collect case reports and analyze the demographic characteristics and patient profiles that may help identify predisposing factors which trigger near-fatal and fatal asthma episodes.

METHODS

In order to gather case reports and analyze the demographics and clinical characteristics of patients experiencing near-fatal and fatal asthma, a questionnaire on near-fatal and fatal asthma was distributed to 400 regional asthma specialists.

RESULTS

Forty physicians reported 25 cases of near-fatal asthma and 20 cases of fatal asthma. Twenty-five patients (13 males and 12 females) with a mean age of 29.4 years experienced near-fatal asthma. The time of onset of the near-fatal event was sudden (less than 3 hours) in 60% of cases and 76% of the episodes occurred at home or en route to the hospital. All 25 patients were using short acting inhaled beta agonists and 88% were reportedly using inhaled corticosteroids on a daily basis. Good to excellent compliance was noted in 60% of patients. Six patients were using a peak flow meter prior to their near-fatal attack. Predisposing psychosocial factors for life threatening asthma were noted in 44% of patients. Twenty patients, (4 males and 16 females) with a mean age of 21.7 years experienced fatal asthma. The time of onset of the fatal event was sudden (less than 3 hours) in 80% of cases and all but one patient died at home, en route to the hospital, or in a public place. All 20 patients were using short acting inhaled beta agonists, 80% were reportedly on daily inhaled corticosteroids and six patients were on oral corticosteroids. Good to excellent compliance was noted in 60% of patients. Only two patients were using a peak flow meter immediately prior to their fatal attack. Predisposing psychosocial factors for life threatening asthma were noted in 45% of decedent patients. Risk factors for fatal asthma included running in cold weather, over relying on home nebulizers, and a delay in seeking care on long holiday weekends.

CONCLUSIONS

While approximately 50% of the patients in this survey had moderate to severe asthma tainted by adverse psychosocial factors, nearly half of near-fatal and fatal attacks occurred suddenly and unexpectedly, outside the hospital in stable, younger, atopic, reportedly compliant patients utilizing inhaled corticosteroids on a daily basis. This regional survey supports the need for additional studies and the establishment of a national case registry to collect case reports and analyze the demographics and clinical characteristics of patients experiencing near-fatal and fatal asthma in order to further define the risk factors and develop preventative protocols for patients at risk for near-fatal or fatal asthma.