[Non-compliance resulting in fatal asthmatic attack in a 27-year-old woman].
We describe a case of fatal asthmatic attack in 27-year-old woman with type II brittle asthma and pollinosis. Despite recurrent episodes of severe asthmatic attacks she refused prolonged therapy with the exception of beta 2-agonists used when needed. The day prior to the fatal attack she was intensively exposed to pollens. She ineffectively tried to manage the attack with high doses of beta 2-agonists administered by MDI and jet nebulizer. After being intubated and transferred to the hospital, she was ventilated mechanically and treated intensively with high doses of corticosteroids, beta 2-agonists, both intravenously and in nebulisation, and nebulised with anticholinergics, but remained unresponsive to the therapy. She gradually deteriorated and died after nine hours of treatment. We conclude that the unresponsiveness to the treatment was mainly due to down-regulation of beta 2-receptors and point out the necessity of regular treatment with inhaled corticosteroids in patients with brittle asthma type II, even in the absence of symptoms.
Barg
Wojciech
W
Oddział Intensywnej Opieki Astmologicznej Katedry i Kliniki Chorób Wewnetrznych i Alergologii AM we Wrocławiu.
Obojski
Andrzej
A
Panaszek
Bernard
B
Markowska-Woyciechowska
Alicja
A
Wytrychowski
Krzysztof
K
Małolepszy
Józef
J
D000328:Adult; D000485:Allergens / Q000009:adverse effects; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D001980:Bronchi / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D009130:Muscle, Smooth / Q000473:pathology; D011058:Pollen / Q000009:adverse effects; D013902:Radiography, Thoracic; D013224:Status Asthmaticus / Q000209:etiology; D016312:Treatment Refusal
D000485:Allergens