A Community-Based Study of Near-Fatal Asthma

Abstract

Purpose of the Study. The objective of this study was to identify possible risk factors associated with fatal and near-fatal asthma in the Washington, DC, area during the time period in which the National Institutes of Health guidelines for the treatment of asthma have been available.Study Populations. Participants were residents of the DC area who had a near-fatal or fatal asthma episode between January 1 and December 31, 1993. The 35 subjects in the study included both adults and children from local intensive care units (ICUs) who required endotracheal intubation for respiratory failure attributable to asthma. There were 33 near-fatal episodes and 2 deaths. Average age was 29.3 (±15.5) years; 14 (45.2%) were under 18 years old. The male to female ratio was 1.58. Eighty-four percent of subjects were African American, 12.9% were Caucasian, and 3.2% were Hispanic.Methods. Participants or proxies were contacted within 2 weeks of their ICU admission. A letter was then sent to explain the study, followed-up by a telephone call for verbal consent and administration of a questionnaire. A supplemental questionnaire was administered to the family member or friend who had the most knowledge of the patient’s activities for the 24 hours before the hospital admission.Results. The demographic information indicated a higher percentage of African Americans (84%) with near fatal asthma compared with the overall African American population in DC (64.8%). For subjects under 18 years old, the average length of diagnosis before the admission was only 2 (±0.05) years, versus 25.5 (±6.6) years for subjects over 18 years old. Forty percent of subjects had daily symptoms and 6.7% had no reported symptoms. Thirty-eight and 7 tenths percent stated they were sick with asthma “all the time” and 16.1% reported never having had an asthma attack prior to this admission. Forty-eight percent had never been hospitalized, 20.7% had been hospitalized 1 to 3 times, and 17.6% had >7 hospitalizations before this admission. Almost 67% had a previous history of intubation. Forty percent had a history of anaphylaxis or drug allergy. Ten percent of the subjects who were under 18 and 44% who were over the age of 18 had a history of smoking. Sixteen percent of the subjects reported not taking any asthma medications and 80% had a prescription for a short-acting |gb2-agonist. Older subjects reported having more severe symptoms than patients <18 years old. Only 64.3% of the subjects contacted a health care provider during the 24 hours before admission. Mortality rates for DC were higher in females and in African Americans.Conclusions. According to this study, age is a risk factor for fatal and near-fatal asthma. The lack of use of an antiinflammatory medications and the reliance on short-acting |gb-agonists were also clear risk factors. Other risk factors, such as lack of access to health care and psychosocial issues, were also noted.Reviewers’ Comments. This article presents several key risk factors for life-threatening asthma that may assist health care providers in recognizing those high-risk asthmatics. There were some weaknesses of the study that were also mentioned by the author, including the lack of a control group, the fact that data were based on self- or proxy reportings, and that the study was limited to 1 urban community. Overall, however, any data on the risk factors for fatal asthma are worth noting.