Potentially fatal asthma: the problem of noncompliance.

In spite of available pharmacologic therapy that controls even the most severe cases of asthma, the mortality rate from asthma continues to rise. Patients with potentially fatal asthma (PFA) must be identified and then treated in a manner that will prevent potentially fatal episodes of asthma. Such management will not result in control of patients with PFA when the patient is not compliant with the medical regimen. We report and classify ten PFA patients according to the apparent psychologic abnormality that resulted in, or contributed to the noncompliance. Some of these psychologic abnormalities in patients with PFA such as adolescent noncompliance, prednisonephobia or bipolar affective disorders may be responsive to a combination of medical and psychiatric management. Other psychiatric diseases that may occur in patients with PFA, such as antisocial personality disorders or schizophrenia, may have a poor prognosis even with combined medical and psychiatric care. The managing physician should be aware of the grave prognosis in such cases.