Kolbe J, Fergusson W, Garrett J
Department of Respiratory Medicine, Green Lane Hospital, Auckland, New Zealand.
Thorax. 1998 Apr;53(4):241-7. doi: 10.1136/thx.53.4.241.
Studies of asthma death and severe life threatening asthma (SLTA) include reports of patients who had rapid onset asthma. A study was undertaken to determine the relative frequency of rapid (< 6 hours duration) and slow (> or = 6 hours) onset attacks in patients admitted to hospital with acute severe asthma, and to establish whether those with rapid onset asthma differ in terms of risk factors for asthma morbidity and mortality such as indices of asthma severity/control, socioeconomic factors, health care, and psychological factors.
A cross sectional study was performed on 316 patients aged 15-49 years admitted with acute severe asthma and interviewed within 24-48 hours of admission.
Patients underestimated the duration of the index attack. Only 27 (8.5%) were classified as rapid onset. There were more men in the rapid onset group than in the slow onset group (52% versus 26%), and there was evidence of socioeconomic advantage in the patients with rapid onset attacks. The rapid onset group had more previous episodes of SLTA and were more likely to present with SLTA, but there was no difference in length of stay in hospital. The rapid onset group were less likely to have presented to a GP during the index attack and were more likely to have used ambulance services. There was no difference between the groups in any psychological or health care measure.
Rapid onset attacks are an important but uncommon manifestation of asthma that are more likely to present with SLTA in patients who are more likely to have had previous SLTA. Male subjects are at increased risk of rapid onset attacks, and socioeconomic disadvantage, deficiencies in health care (ongoing and acute), and psychological factors are no more common in these patients than in those with attacks of slow onset. These data are consistent with the hypothesis that there is a small proportion of patients with rapid onset severe asthma who do not have the usual risk factors associated with asthma morbidity or mortality, and thus require different management strategies.
哮喘死亡和严重危及生命的哮喘（SLTA）研究包括了快速发作哮喘患者的报告。开展了一项研究，以确定急性重度哮喘住院患者中快速发作（持续时间<6小时）和缓慢发作（持续时间≥6小时）的相对频率，并确定快速发作哮喘患者在哮喘发病和死亡风险因素方面是否存在差异，如哮喘严重程度/控制指标、社会经济因素、医疗保健和心理因素。
对316名年龄在15 - 49岁的急性重度哮喘住院患者进行了横断面研究，并在入院后24 - 48小时内对其进行访谈。
患者低估了首次发作的持续时间。只有27例（8.5%）被归类为快速发作。快速发作组的男性多于缓慢发作组（52%对26%），并且有证据表明快速发作患者具有社会经济优势。快速发作组既往SLTA发作次数更多，且更有可能以SLTA形式就诊，但住院时间无差异。快速发作组在首次发作时看全科医生的可能性较小，使用救护车服务的可能性较大。两组在任何心理或医疗保健指标方面均无差异。
快速发作是哮喘的一种重要但不常见的表现，在既往更有可能发生SLTA的患者中更有可能以SLTA形式出现。男性快速发作的风险增加，社会经济劣势、医疗保健不足（持续和急性）以及心理因素在这些患者中并不比缓慢发作患者更常见。这些数据与以下假设一致，即一小部分快速发作的重度哮喘患者没有与哮喘发病或死亡相关的常见风险因素，因此需要不同的管理策略。
