Near-Fatal Asthma

By Mark D. Siegel, MD, FCCP

Print This | TOC | Previous | Next

Outcome and Follow-up

Most patients who present alive to the hospital will, with standard care, survive their acute illness. Although some respond quickly to therapy, others, especially those who present only after several days of symptoms, may take longer. Since the landmark study by Darioli and Perret⁵³ establishing the benefit of controlled hypoventilation, the mortality associated with mechanical ventilation for asthma has generally ranged from 0 to 4%,^53,55,71 a substantial decrease compared with the mortality rate of up to 38% reported in studies from the late 1960s through the early 1980s.⁵²

One recent study, in contrast, showed a 21% mortality rate among patients requiring mechanical ventilation.⁴ Factors associated with increased mortality included an increased APACHE (acute physiology and chronic health evaluation) II score, increased PaCO₂, decreased arterial pH, the development of sepsis, and multiple organ dysfunction. Although not statistically significant, all patients who died were female. Tension pneumothorax and cardiac arrest prior to medical ICU admission were common in nonsurvivors.⁴ The authors speculated that inadequate prehospital care, excessively aggressive positive pressure ventilation prior to arrival at the hospital, and nosocomial infections may have contributed to the high mortality rate.⁴

Patients who survive an episode of acute, severe asthma frequently succumb to repeat attacks. One study found mortality rates of 10.1% at 1 year, 14.4% at 3 years, and 22.6% at 6 years after mechanical ventilation.⁷² The need for careful outpatient monitoring and treatment, preferably in a subspecialty clinic, is critical. Careful follow-up, including regular peak flow monitoring, close physician communication, patient education, and a therapeutic plan centered around the use of inhaled corticosteroids should decrease the risk of recurrent attacks.

Print This | TOC | Previous | Next

3300 Dundee Road • Northbrook, Illinois 60062-2348 • (847) 498-1400 • (800) 343-2227
Copyright ©1999-2008 American College of Chest Physicians. All Rights Reserved.
ACCP Privacy Policy | ACCP Web Site Terms of Use