Near-Fatal Asthma

By Mark D. Siegel, MD, FCCP

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Epidemiology

From 1982 to 1991, the annual age-adjusted mortality from asthma increased from 13.4 to 18.8 per million.³ Blacks, women, and inner-city patients are at greatest risk.⁴ Given the right conditions, almost any asthmatic can develop a fatal or near-fatal attack.⁵

McFadden⁶ has emphasized four factors predisposing patients to severe attacks: pre-existing obstruction, airway lability, a stimulus, and patient response. Specific risk factors include prior severe attacks (especially those requiring mechanical ventilation), nonadherence to therapy, age > 40 years, and cigarette smoking (Table 1).^5,7-10 A diminished ability to sense and respond to airway obstruction occurs in some.¹¹

Frequent b-agonist use is closely linked to fatal asthma.^7,8 Although some cite b-agonists as an independent risk factor for severe disease, it is more likely that frequent use simply identifies patients with poorly controlled asthma. In contrast, an inverse correlation exists between the number of containers of inhaled corticosteroids used per year and the risk of fatal attacks.¹

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