Greenberger P A, Patterson R
Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611.
N Engl Reg Allergy Proc. 1988 Mar-Apr;9(2):147-52. doi: 10.2500/108854188778994968.
The concept of life-threatening asthma is not new. Reviews of fatal asthma often describe retrospectively identified factors that were associated with or contributed to the patient's demise. We report 55 patients considered to have the diagnosis of potentially fatal asthma who were managed for 4.8 +/- 4.3 years per patient. The diagnostic criteria of potentially fatal asthma included at least one of the following four potentially fatal asthma events: 1) mechanical ventilation for respiratory arrest or failure, 2) acute respiratory acidosis that did not necessitate mechanical ventilation, 3) two episodes of acute pneumomediastinum or pneumothorax associated with status asthmaticus, 4) two or more hospitalizations for status asthmaticus in spite of long term oral corticosteroids. The mean age of patients with potentially fatal asthma was 39.6 +/- 19.1 (range 8.5-79.5 years). During 262 patient-years of management, one 79 year old demented patient died from disseminated cryptococcal infection. Two patients died from asthma after leaving our service, one patient having left the hospital against medical advice with arterial blood gases demonstrating acute respiratory acidosis during status asthmaticus. Fifty-two patients are alive and ambulatory. Long-term corticosteroids have been essential in 43 of 45 patients in this series currently managed by full-time faculty of the Northwestern University Allergy Service. Complicating psychosocial factors of some patients with potentially fatal asthma include schizophrenia, bipolar disorders, denial of disease, adolescent non-compliance, and parental interference with essential medications for children. We believe that the diagnosis of potentially fatal asthma should be made following occurrence of major asthma events that place the patient at high risk for a death from asthma.
危及生命的哮喘这一概念并不新鲜。对致命性哮喘的回顾性分析常常描述那些与患者死亡相关或导致患者死亡的因素。我们报告了55例被诊断为潜在致命性哮喘的患者，每位患者的治疗时间为4.8±4.3年。潜在致命性哮喘的诊断标准包括以下四种潜在致命性哮喘事件中的至少一种：1）因呼吸骤停或呼吸衰竭进行机械通气；2）无需机械通气的急性呼吸性酸中毒；3）与哮喘持续状态相关的两次急性纵隔气肿或气胸发作；4）尽管长期口服皮质类固醇，但因哮喘持续状态住院两次或更多次。潜在致命性哮喘患者的平均年龄为39.6±19.1岁（范围8.5 - 79.5岁）。在262个患者年的治疗期间，一名79岁的痴呆患者死于播散性隐球菌感染。两名患者在离开我们的治疗后死于哮喘，其中一名患者违背医嘱出院，其动脉血气显示在哮喘持续状态时存在急性呼吸性酸中毒。52名患者存活且可自由活动。在本系列目前由西北大学过敏科全职教员管理治疗的45名患者中，有43名患者长期使用皮质类固醇至关重要。一些潜在致命性哮喘患者存在复杂的社会心理因素，包括精神分裂症、双相情感障碍、否认病情、青少年不依从以及父母对儿童必要药物的干扰。我们认为，在发生使患者面临哮喘死亡高风险的重大哮喘事件后，应作出潜在致命性哮喘的诊断。
