RT Journal Article
SR Electronic
T1 The WHO classification of severe asthma in intensive care patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p880
VO 38
IS Suppl 55
A1 T.K. Lim
A1 L. Prabakaran
A1 J. Abisheganaden
A1 G. Chua
A1 B.H. Heng
A1 Y. Sun
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p880.abstract
AB In 2010 a WHO consultative group proposed a definition of severe asthma (JACI 2010; 126:926-3). We have applied this classification to a series of adult patients managed in the intensive care units of 3 large urban hospitals.Over a 5yr. period (2006-2010), we registered 386 intensive care admissions for asthma in 332 patients. Their mean age was 53 (18)yrs, 57% were women, 48% Chinese, 27% Malays and 14% Indian. Mechanical ventilation was needed in 82% and there were 26 deaths. According to the WHO classification method, the severe asthma, in the first 127 patients, was: untreated in 81 (64%), difficult-to-treat in 41 (32%) and treatment-resistant in 5 (4%). These 3 groups of patients corresponded to distinct and recognizable clinical phenotypes with implications for asthma intervention plans. The untreated patients were from primary care and not attending regular reviews nor receiving long-term control medications. The difficult-to-treat patients were characterized by co-morbidities, non-adherence and under-treatment.We need more effective interventions to reduce the burden of severe asthma at the primary care level. Sub-optimal treatment appeared to be the main barrier to asthma control. Genuine treatment-resistant asthma was an uncommon problem.