title: [Non-compliance resulting in fatal asthmatic attack in a 27-year-old woman].
abstract: 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.
authors.affiliation: Oddział Intensywnej Opieki Astmologicznej Katedry i Kliniki Chorób Wewnetrznych i Alergologii AM we Wrocławiu.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Barg
authors.forename: Andrzej
authors.initials: A
authors.lastname: Obojski
authors.forename: Bernard
authors.initials: B
authors.lastname: Panaszek
authors.forename: Alicja
authors.initials: A
authors.lastname: Markowska-Woyciechowska
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wytrychowski
authors.forename: Józef
authors.initials: J
authors.lastname: Małolepszy
mesh_terms: 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
chemical_list: D000485:Allergens