Risk factors of near - fatal asthma

Choi, Inseon S; Park, Seog Chea; Jang, Ahn Soo; Kang, Kwang Won; Lim, Ho

Abstract

BACKGROUND: Researches on the characteristics of fatality-prone asthmatics have been performed in western countries, but there are few reports in this field in Korea. The purposes of this study were to clarify the magnitude of the problem and to identify the risk factors of near-fatal asthma(NFA).
METHODS
The records of patients admitted due to asthma attack were analyzed retrospectively.
RESULTS
1) The subjects had NFA in 50.6% and PaCO2 > 45mmHg in 22.9%. Five(11.1%) among NFA patients and 3 out of 19(15.8%) subjects with PaCO2 > 45mmHg required mechanical ventilation. 2) There were no significant differences between NFA and non-NFA in age, sex, resident place, academic career, familial and personal history of atopic diseases, serum total IgE level, positive skin prick test to house dust mites, accompanying allergic rhinitis and aspirin intolerance, emphysema on chest high resolution computerized tomogram, dyspnea perception, previous asthma education, regular OPD follow-up, and use of antiinflammatory drugs. 3) However, cigarette smoking(62.2% vs 38.6%), accompanying paranasal sinusitis(66.7% vs 45.3%), chronic asthma severity(severe persistent: 55.5% vs 29.5%), hospitalization frequency(2.93 vs 1.58), and duration of recent asthma exacerbation(6.6 vs 18.8 days) in NFA were significantly different from those in non-NFA.4) The relative risk for NFA was high in patients with history of hospitalization > 3, severe persistent asthma, exacerbation period < 3 days, smoking, or sinusitis in the order of frequency.
CONCLUSION
Near-fatal asthma is a prevalent problem in clinical practice and asthma admission history, severe persistent asthma, short exacerbation period < 3 days, smoking, and paranasal sinusitis are the risk factors warning near-fatal asthma attack in advance.