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Frequency and clinical characteristics of rapid-onset fatal and near-fatal asthma

¹ Dept of Pneumology, Hospital of the Santa Creu and Sant Pau and ² Pneumology and Respiratory Allergy Service, Hospital Clinic, Barcelona, Spain

CORRESPONDENCE: V. Plaza, Dept de Pneumologia, Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret 167, 08025, Barcelona, Spain. Fax: 34 932919266. E-mail: vplaza@hsp.santpau.es

Keywords: asthma, asthma classification, asthmatic crisis, asthma mortality, fatal asthma, rapid-onset asthma

Received: April 30, 2001
Accepted November 20, 2001

This study was supported by a grant of Fundación Española de Neumología y Cirugía Torácica (FEPAR) 1996 and Sociedad Española de Neumología y Cirugía Torácica (SEPAR) 1998.

The onset of fatal and near-fatal asthma attacks can be rapid. The objective of this study was to determine the frequency and clinical characteristics of rapid-onset asthma (ROA) in patients suffering fatal and near-fatal crises.

Two-hundred and twenty patients with fatal or near-fatal attacks were enrolled in a multicentre, prospective study. ROA was defined as a crisis developing in 2 h. Data on patient and clinical characteristics were collected, and spirometric and allergy studies were performed when the patients were in a stable condition.

Forty-five attacks (20%) were ROA and 175 (80%) were slow-onset asthma (SOA). The triggers for SOA and ROA attacks were different, with the ROA group having a significantly lower rate of suspected respiratory infection (7% versus 38%), higher rates of fume/irritant inhalation (9% versus 1%) and a higher intake of nonsteroidal anti-inflammatory drugs (14% versus 3%). The ROA group exhibited significantly higher rates of impaired consciousness (63% versus 44%), absence of lung sounds upon admission (68% versus 42%), fewer hours of mechanical ventilation (13 h versus 28 h) and fewer days of hospitalization (8 days versus 9.5 days) than the SOA group.

The 20% frequency of rapid-onset fatal and near-fatal attacks in this study suggests that rapidly developing attacks may not be rare. These findings also support a distinct clinical profile for rapid-onset asthma marked by differences in triggers, severity of exacerbation and clinical course.

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