Riou B, Barriot P, Duroux P
Service de Pneumologie et de Réanimation, Hôpital Antoine-Béclère, Clamart.
Rev Mal Respir. 1988;5(4):353-61.
Fatal asthma is rare but constitutes a serious public health problem on account of the raised prevalence of the disease. The incidence of fatal asthma is estimated at 3/100,000 people in France and the incidence of fatal asthma has not ceased to rise in the world despite therapeutic progress. The principal risk factors recognised are: 1. longstanding asthma, 2. unstable asthma, 3. acute severe asthma with a prior history, 4. insufficiently treated asthma or poorly compliant patient, 5. the absence of surveillance by peak flow measurements, etc. The socio-economic factors and above all the psychological factors play a role which is not negligible. A poor evaluation of the severity of the crisis by the asthmatic has been suggested as a factor, but it is possible that the rapidity of the progression of the crisis in fatal asthma may be responsible for the physical inability of the patient to react to the situation. There is no reason to incriminate beta-mimetic agents in fatal asthma. The prevention rests on an improvement in treatment, the education of the asthmatic and an improvement in medical teaching. However, only improvement in the speed of admission of emergency cases will effectively permit a reduction in the incidence of fatal asthma. The system of auto-admission of patients at risk should be reserved for co-operative patients but the systematic medicalization for urgent cases of asthma merits further development. A better definition of the asthmatic population at risk for fatal asthma is necessary.
致死性哮喘虽罕见，但鉴于该疾病患病率上升，它构成了一个严重的公共卫生问题。法国致死性哮喘的发病率估计为十万分之三，尽管治疗取得进展，但致死性哮喘的发病率在全球仍持续上升。已确认的主要风险因素有：1. 长期哮喘；2. 不稳定型哮喘；3. 有既往史的急性重度哮喘；4. 治疗不充分或患者依从性差的哮喘；5. 未通过峰流速测量进行监测等。社会经济因素尤其是心理因素起着不可忽视的作用。有观点认为哮喘患者对病情严重程度评估不足是一个因素，但也有可能是致死性哮喘病情进展迅速导致患者身体无法对病情做出反应。没有理由将β - 拟交感神经药归咎于致死性哮喘。预防措施包括改善治疗、对哮喘患者进行教育以及改进医学教学。然而，只有提高急诊入院速度才能有效降低致死性哮喘的发病率。针对有风险患者的自动入院系统应仅适用于合作的患者，但哮喘急症的系统化医疗救治值得进一步发展。有必要更好地界定有致死性哮喘风险的哮喘患者群体。
