Fatal and near-fatal asthma have been the subject of much interest and study. By obtaining as much information as possible on persons who die or almost die of asthma, we can learn how to prevent similar deaths in the future.
Fatal Asthma: Risk Factors
- Prior history of sudden, rapidly progressive severe exacerbations
- Prior history of intubation for asthma, ever
- Prior history of admission to an intensive care unit (ICU) for asthma, ever
- Two or more hospitalizations for asthma in the last 12 months
- Three or more visits to a hospital emergency room for asthma exacerbation in the last 12 months
- Either an emergency room visit or a hospitalization for asthma in the last 30 days
- Asthma requiring the use of two (or more) canisters of rescue quick-relief short-acting β2 agonist inhalers in the last 30 days
- Current requirement for and use of oral (pill form) steroid medication
- Recent steroid taper
- Allergy or sensitivity to mold (Alternaria test)
- Lack of awareness of worsening asthma; difficulty in perceiving worsening asthma symptoms
- Other superimposed complicating serious medical illnesses (heart disease, diabetes, etc.)
- Serious psychiatric illness
- Severe psychosocial problems
- Lower socioeconomic status
- Urban residence
- Illicit “recreational” drug use and/or abuse
The majority of persons with near-fatal or fatal asthma tend to underestimate the severity of their symptoms and present for care only after several days of clearly worsening symptoms. The symptoms are usually responses to triggers that can include a viral infection, intense expo-sure to allergens, nonadherence to prescribed asthma treatment, air pollution, changes in weather, or severe emotional stress.
If someone waits for a period of days before intervening to control the exacerbation, the opportunity for effective treatment is lost; in other words, it is too late by the time help is on the way. In most cases of fatal or near-fatal asthma, the actual disease can be con-trolled, but human patient factors adversely modify the outcome.
The more unusual scenario of very rapidly progressive asthma that exacerbates dramatically over the course of several hours occurs in the minority of patients with near-fatal or fatal asthma. Some individuals have a particularly aggressive and severe type of asthma that, despite ideal and perfect compliance with medical treatment and recommendations, does lead to severe complications. Those persons should be under the care of an asthma specialist and may be candidates for cutting-edge therapies.