medigraphic.com
A partir del año 2010, la Revista Oficial del INER cambió a NCT (Neumología y Cirugía de Tórax)

 Ver actualización

2009, Number 1

<< Back Next >>

Rev Inst Nal Enf Resp Mex 2009; 22 (1)

Prevalence of near-fatal asthma in the intensive care unit of the National Institute of Respiratory Diseases

Guillén-Ortega FC, Martínez-Padilla J, Salas-Hernández J

Language: Spanish
References: 21
Page: 14-20
PDF size: 68.27 Kb.


ABSTRACT

Introduction: Asthma is a chronic inflammatory disease involving many different cell types and cellular elements. All patients with asthma are at risk of having exacerbations, which may range from mild to life-threatening. Near-fatal asthma (NFA) and fatal asthma represent the most severe clinical presentations of asthma. Patients with NFA usually require admission to an intensive care unit. The aim of this study was to determine the prevalence and clinical course of patients with NFA at a respiratory intensive care unit (RICU).
Methods: Clinical records of patients admitted to the RICU from July 2005 to July 2008 with diagnosis of NFA were reviewed. Data collected included epidemiological characteristics, prior intubation, chest radiograph, initial arterial pH and PaCO2, length of RICU stay, and complications.
Results: The prevalence of NFA in the study period was 2.3%. The group was integrated by 25 patients (7 males and 18 females), with a mean age of 32 years. A 40% of all patients had a history of hospital admission within the past year and 16% had already been at the RICU. Asthma severity was assessed using the GINA criteria: 9 (36%) patients were intermittent, 8 (32%) were mild-moderate persistent and 8 (32%) were severe persistent. The time of onset of the near-fatal event was sudden (‹ 6 hours) in 28%. Respiratory infections (76%) and non-steroid anti-inflammatory drugs (20%) were the principal causes of asthma attacks. Eighty percent patients required mechanical ventilation. There were no deaths.
Conclusion and comment: The prevalence of NFA was lower than other studies. Recognition of risk factors and understanding of the pathophysiology of NFA are important to optimize the evaluation and therapy during their exacerbations and to decrease the rate of events.


REFERENCES

  1. Global Initiative for Asthma, National Heart, Lung, and Blood Institute. Global strategy for asthma management and prevention. NIH publication, No. 02-3659. Bethesda: National Institutes of Health, National Heart, Lung, and Blood Institute; 2002.

  2. Rea HH, Scragg R, Jackson R, Beaglehole R, Fenwick J, Sutherland DC. A case-control study of deaths from asthma. Thorax 1986;41:833-839.

  3. Turner MO, Noertjojo K, Vedal S, Bai T, Crump S, Fitzgerald JM. Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma. Am J Respir Crit Care Med 1998;157(6 Pt 1):1804-1809.

  4. Plaza V, Serrano J, Picado C, Sanchís J; and High Risk Asthma Research Group. Frequency and clinical characteristics of rapid-onset fatal and near-fatal asthma. Eur Respir J 2002;19:846-852.

  5. Centers for Disease Control and Prevention. [homepage on the Internet]. Atlanta: Centers for Disease Control and Prevention. [cited 2007 Mar 10]. Asthma. Available from: www.cdc.gov/asthma/asthmadata.htm

  6. Division of Data Services. Asthma prevalence: health care use and mortality, 2001-2001. Hyattsville, MD: National Center for Health Statistics; 2002.

  7. Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: Final data for 2002. National vital statistics reports; 53 N° 5. Hyattsville: National Center for Health Statistics; 2004.

  8. Salmeron S, Liard R, Elkharrat D, Muir J, Neukirch F, Ellrodt A. Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study. Lancet 2001;358:629-635.

  9. Braman SS, Kaemmerlen JT. Intensive care of status asthmaticus. A 10-year experience. JAMA 1990;264: 366-368.

  10. Trawick DR, Holm C, Wirth J. Influence of gender on rates of hospitalization, hospital course, and hypercapnea in high-risk patients admitted for asthma: a 10-year retrospective study at Yale-New Haven hospital. Chest 2001;119:115-119.

  11. Miller MK, Johnson C, Miller DP, Deniz Y, Bleecker ER, Wenzel SE; and TENOR Study Group. Severity assessment in asthma: an evolving concept. J Allergy Clin Immunol 2005;116:990-995.

  12. Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. Chest 2004;125:1081-1102.

  13. Mitchell I, Tough SC, Semple LK, Green FH, Hessel PA. Near-fatal asthma: a population-based study of risks factors. Chest 2002;121:1407-1413.

  14. Rodrigo C. Severe acute asthma: its management in emergency visits and intensive care. Med Intensiva 2006;30:460-470.

  15. Rodrigo GJ, Rodrigo C, Nannini LJ. Asma fatal o casi fatal: ¿entidad clínica o manejo inadecuado? Arch Bronconeumol 2004;40:24-33.

  16. Rodrigo GJ, Rodrigo C. Rapid-onset asthma attack: a prospective cohort study about characteristics and response to the emergency department treatment. Chest 2000;118:1547-1552.

  17. Restrepo RD, Peters J. Near-fatal asthma: recognition and management. Curr Opin Pulm Med 2008;14:13-23.

  18. Rodriguez-Roisin R. Acute severe asthma: pathophysiology and pathobiology of gas exchange abnormalities. Eur Respir J 1997;10:1359-1371.

  19. Han P, Cole RP. Evolving differences in the presentation of severe asthma requiring intensive care unit admission. Respiration 2004;71:458-462.

  20. Rodrigo GJ, Plaza V, Forns SB, Tordera MP, Salas J. Factors associated with mortality in patients hospitalized in Spain and Latin America for acute severe asthma in 1994, 1999, and 2004. J Bras Pneumol 2008; 34:546-551.

  21. Zimmerman JE, Galler LH, Judson JA, Streat SJ, Trubuhovich RV. Severity stratification in life-threatening asthma. J Intensive Care Med 1990;5:120-127.




2020     |     www.medigraphic.com