Restrepo Ruben D, Peters Jay
Department of Respiratory Care, University of Texas Health Science Center, San Antonio 78229, USA.
Curr Opin Pulm Med. 2008 Jan;14(1):13-23. doi: 10.1097/MCP.0b013e3282f1982d.
Near-fatal asthma continues to be a significant problem despite the decline in overall asthma mortality. The purpose of this review is to discuss recent advances in our understanding of the pathophysiology, diagnosis and treatment of near-fatal asthma.
Two distinctive phenotypes of near-fatal asthma have been identified: one with eosinophilic inflammation associated with a gradual onset and a slow response to therapy and a second phenotype with neutrophilic inflammation that has a rapid onset and rapid response to therapy. Patients who develop sudden-onset near-fatal asthma seem to have massive allergen exposure and emotional distress. In stable condition, near-fatal asthma frequently cannot be distinguished from mild asthma. Diminished perception of dyspnea plays a relevant role in treatment delay, near-fatal events, and death in patients with severe asthma. Reduced compliance with anti-inflammatory therapy and ingestion of medications or drugs (heroin, cocaine) have been associated with fatal or near-fatal asthma.
Near-fatal asthma is a subtype of asthma with unique risk factors and variable presentation that requires early recognition and aggressive intervention.
尽管哮喘总体死亡率有所下降，但濒死性哮喘仍然是一个重大问题。本综述的目的是讨论我们对濒死性哮喘的病理生理学、诊断和治疗的最新认识进展。
已识别出两种不同的濒死性哮喘表型：一种伴有嗜酸性粒细胞炎症，起病缓慢且对治疗反应迟钝；另一种为中性粒细胞炎症表型，起病迅速且对治疗反应迅速。突发濒死性哮喘的患者似乎有大量过敏原暴露和情绪困扰。在稳定状态下，濒死性哮喘常常无法与轻度哮喘相区分。呼吸困难感知减弱在重度哮喘患者的治疗延迟、濒死事件及死亡中起相关作用。抗炎治疗依从性降低以及摄入药物（海洛因、可卡因）与致命性或濒死性哮喘有关。
濒死性哮喘是哮喘的一种亚型，具有独特的危险因素和可变的表现形式，需要早期识别和积极干预。
