American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 740-759, (2003)
© 2003 American Thoracic Society
Acute Severe Asthma
E. R. McFadden, Jr.
Center for Academic Clinical Research, Case Western Reserve University School of Medicine; and Division of Pulmonary and Critical Care Medicine of MetroHealth Medical Center, Cleveland, Ohio
Correspondence and requests for reprints should be addressed to E. R. McFadden, Jr., M.D., Division of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109-1998. E-mail: erm2{at}po.cwru.edu
Acute severe asthma remains a major economic and health burden. The natural history of acute decompensations is one of resolution and only about 0.4% of patients succumb overall. Mortality in medical intensive care units is higher but is less than 3% of hospital admissions. "Near-fatal" episodes may be more frequent, but precise figures are lacking. However, about 30% of medical intensive care unit admissions require intubation and mechanical ventilation with mortality of 8%. Morbidity and mortality increase with socioeconomic deprivation and ethnicity. Seventy to 80% of patients in emergency departments clear within 2 hours with standardized care. The relapse rate varies between 7 and 15%, depending on how aggressively the patient is treated. The airway obstruction in the 20–30% of people resistant to adrenergic agonists in the emergency department slowly reverses over 36–48 hours but requires intense treatment to do so. Current therapeutic options for this group consist of ipratropium and corticosteroids in combination with ß2 selective drugs. Even so, such regimens are not optimal and better approaches are needed. The long-term prognosis after a near-fatal episode is poor and mortality may approach 10%.
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Copyright © 2003 American Thoracic Society
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