Part 2: Acute asthma, prognosis, and treatment

Jennifer E. Fergeson, DO, Shiven S. Patel, MD, and Richard F. Lockey, MD

Asthma affects about 300million people globally and accounts for 1 in every 250 deaths in the world. Approximately 12 million people in the United States each year experience an acute
exacerbation of their asthma, a quarter of which require hospitalization.

Read Part 1 Here.

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PREDICTORS OF FATAL OR NEAR-FATAL ASTHMA

Major risk factors for near-fatal and fatal asthma are recognized, and their presence makes early recognition and
treatment of an asthma exacerbation essential. The history should include a review of previous episodes of near-fatal asthma and whether the patient has experienced multiple emergency department visits or hospitalizations, particularly those requiring admission to an intensive care unit, involving respiratory failure, intubation, and mechanical ventilation. A history of allergic asthma and other known or suspected allergic symptoms should
be obtained. For example, Nelson et al4 identified allergy to the mold Alternaria species and several dust mite species as a trigger for severe asthma.(10)

Adherence to medical treatment should be reviewed; poor adherence with prescribed therapies is a major risk factor. Inadequate therapy can include excessive use of b2-agonists, concomitant use of b-blockers, and failure to prescribe or use inhaled corticosteroids (ICSs) as a primary therapy. Recent withdrawal of oral corticosteroids (OCSs) suggests that the patient is at greater risk for a severe exacerbation. Lack of a written asthma action plan is another risk factor. Limited access of the patient to appropriate health care and lack of education about appropriate management strategies are additional risk factors. Socioeconomic factors associated with severe asthma exacerbations include the nonadherent adolescent or elderly asthmatic patients living in inner-city environments. Certain ethnic groups within a population might have a higher incidence of severe asthma, such as Americans of African or Spanish inheritance. Comorbidities, such as chronic lung, psychiatric,
and cardiovascular diseases are other risk factors.(10,11)