scholarly journals Overreliance on Bronchodilators as a Risk Factor for Life-Threatening Asthma

1995 ◽  
Vol 2 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Pierre Ernst ◽  
Brenda Hemmelgarn ◽  
Donald W Cockcroft ◽  
Samy Suissa
Keyword(s):  
Pharmacological Therapy ◽  
Beta Agonist ◽  
Time Period ◽  
Oral Corticosteroids ◽  
Fatal Asthma ◽  
Life Threatening ◽  
Near Fatal Asthma ◽  
Nested Case Control ◽  
Guide Lines ◽  
Control Study

OBJECTIVE: To assess the potential impact on the risk of life-threatening asthma of current recommendations in pharmacotherapy, which emphasize the early use of steroids and the avoidance of beta-agonist overuse.DESIGN: Nested case-control study.SETTING: Province of Saskatchewan.POPULATION STUDIED: From a cohort of 12,301 subjects dispensed 10 or more asthma medications from 1980 to 1987, 129 case patients were identified who had experienced an episode of fatal or near fatal asthma and 129 control patients matched to the cases on age, time period at risk and severity of asthma (as judged by the need for hospitalization for asthma in the preceding two years).METHODS: Two clinicians reviewed the therapy these 258 subjects had been dispensed over the prior two-year period and classified their treatment as ‘incompatible’ or ‘compatible’ (at least partially compatible) with current pharmacotherapeutic guide lines. In addition to this classification a treatment evaluation score was also applied to each study subject. This score was based on the use of anti-inflammatory therapy (oral and inhaled) in conjunction with the regular use of bronchodilators, as well as the use of oral corticosteroids for patients recently discharged from hospital foll owing an attack or asthma.RESULTS: At least one of the two clinician reviewers judged therapy to be incompatible with current standards in 49% of the case patients compared with 20% of the subjects who had not experienced a life-threatening episode. The mean ± SD treatment score was 3.5±1.7 in cases compared with 0.8±1.4 in controls, suggesting quality or pharmacological treatment was worse in cases (P<0.001).CONCLUSIONS: Pharmacological therapy incompatible with current recommendations was more common among cases of fatal and near fata l asthma in Saskatchewan from 1980 to 1987.

scholarly journals Proceedings of a Workshop on Near Fatal Asthma

1995 ◽  
Vol 2 (2) ◽  
pp. 113-126 ◽  
Author(s):  
J Mark FitzGerald ◽  
Peter T Macklem
Keyword(s):  
At Risk ◽  
Management Strategies ◽  
Beta Agonist ◽  
Ambulatory Care Setting ◽  
Asthma Morbidity ◽  
Beta Agonists ◽  
Asthma Patients ◽  
Fatal Asthma ◽  
Patients At Risk ◽  
Near Fatal Asthma

Concern has been expressed about rising asthma morbidity and mortality, although the latter appears to have declined recently. A reasonable surrogate for fatal asthma is an episode of near fatal asthma (NFA). The etiology of episodes of NFA appears to be multifactorial. Features that would characterize asthma patients at risk of NFA have been difficult to define but have included psychosocial barriers. environmental exposures, inadequate or inappropriate physician and/or patient responses to deteriorating asthma and, in particular, overreliance on symptomatic bronchodilator therapy. The association between fatal asthma and NFA with beta-agonist use has been controversial, with it being argued that high use of beta-agonists reflects severity of asthma as opposed to being causal. Studies in the laboratory and ambulatory care setting suggest that regular compared with as-required use of beta-agonists is associated with worsening in asthma control. Although a reduced perception of dyspnea has been identified in some asthma patients, it is not universally present in those with NFA. Retrospective data suggest that hyperinflation of the thorax, as judged by total lung capacity, may be a useful marker for subjects at risk of NFA. Future studies should better characterize these risk factors and develop management strategies (both therapeutic and educational) that might reduce the risk of subjects experiencing episodes of NFA and, by extension, reducing the continued unacceptable mortality associated with asthma.

Prescription of oral corticosteroids in near-fatal asthma patients: Relationship with panic-fear, anxiety and depression

2005 ◽  
Vol 46 (5) ◽  
pp. 459-465 ◽  
Author(s):  
ESTHER ROMERO-FRAIS ◽  
MARIA ISABEL VAZQUEZ ◽  
EVA SANDEZ ◽  
MARINA BLANCO-APARICIO ◽  
ISABEL OTERO ◽  
...  
Keyword(s):  
Anxiety And Depression ◽  
Asthma Patients ◽  
Oral Corticosteroids ◽  
Fatal Asthma ◽  
Near Fatal Asthma

scholarly journals Severe exacerbation of athma in ICU

2016 ◽  
Vol 63 (2) ◽  
pp. 49-51
Author(s):  
Ivan Kopitovic ◽  
Vladimir Carapic ◽  
Jovan Matijasevic ◽  
Branislav Kovacevic ◽  
Uros Batranovic ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Severe Form ◽  
General Ward ◽  
Diagnostic Methods ◽  
Severe Exacerbation ◽  
Severity Of Disease ◽  
Fatal Asthma ◽  
Life Threatening ◽  
Near Fatal Asthma ◽  
Treatment Procedures

Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals. Grading of asthma based on clinical presentation is going from acute severe asthma over life threatening asthma to near fatal asthma There are only a few diagnostic methods that we can use for patients with severe form of asthma because. This is because of severity of disease which disables them to complete usually used diagnostic tests. Treatment of patients with severe form of asthma is difficult. Today we have precisely defined criteria for hospital admission, so we will not waste time to decide whether patient is of general ward, high dependence unit or intensive care unit. Thanks to latest GINA recommendations we updated about treatment procedures for each patient based on severity of disease. It is extremely important to choose adequate therapy as soon as possible, because we do not have big margin for an error. Therapy should be based on latest GINA recommendation.

CHEMOSENSITIVITY AND PERCEPTION OF DYSPNEA IN PATIENTS WITH A HISTORY OF NEAR-FATAL ASTHMA

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 394-394
Author(s):  
Michael J. Welch ◽  
Bradley E. Chipps
Keyword(s):  
Airway Narrowing ◽  
Fatal Asthma ◽  
Life Threatening ◽  
History Of ◽  
Near Fatal Asthma

A reduced perception of hypoxemia and airway narrowing may play an important role in causing life-threatening attacks of asthma.

Potentially (near) fatal asthma

2019 ◽  
Vol 40 (6) ◽  
pp. 403-405 ◽  
Author(s):  
Paul A. Greenberger
Keyword(s):  
Severe Asthma ◽  
Health Care Professionals ◽  
Rescue Therapy ◽  
Respiratory Acidosis ◽  
Acute Severe Asthma ◽  
Increased Risk ◽  
High Risk Type ◽  
Fatal Asthma ◽  
Long Acting ◽  
Near Fatal Asthma

Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. The diagnosis of PFA should motivate treating physicians, health professionals, and patients to be more aggressive in the monitoring, treatment, and control of this high-risk type of asthma. A diagnosis of PFA is made when any one of the following are present: (1) a history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma, despite the use of long-term oral corticosteroids and other antiasthma medications. There are two predominant phenotypes of near-fatal exacerbations: “subacute” exacerbation and “hyperacute” exacerbation. The best way to “treat” acute severe asthma is 3‐7 days before it occurs (i.e., at the onset of symptoms or change in respiratory function) and to optimize control of asthma by decreasing the number of symptomatic days and the days and/or nights that require rescue therapy and increasing baseline respiratory status in “poor perceivers.” PFA is treated with a multifaceted approach; physicians and health-care professionals should appreciate limitations of pharmacotherapy, including combination inhaled corticosteroid‐long-acting β-agonist products as well as addressing nonadherence, psychiatric, and socioeconomic issues that complicate care.

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