Near-fatal asthma: recognition and management.
OBJECTIVE
Near-fatal asthma continues to be a significant problem despite the decline in overall asthma mortality. The purpose of this review is to discuss recent advances in our understanding of the pathophysiology, diagnosis and treatment of near-fatal asthma.


RESULTS
Two distinctive phenotypes of near-fatal asthma have been identified: one with eosinophilic inflammation associated with a gradual onset and a slow response to therapy and a second phenotype with neutrophilic inflammation that has a rapid onset and rapid response to therapy. Patients who develop sudden-onset near-fatal asthma seem to have massive allergen exposure and emotional distress. In stable condition, near-fatal asthma frequently cannot be distinguished from mild asthma. Diminished perception of dyspnea plays a relevant role in treatment delay, near-fatal events, and death in patients with severe asthma. Reduced compliance with anti-inflammatory therapy and ingestion of medications or drugs (heroin, cocaine) have been associated with fatal or near-fatal asthma.


CONCLUSIONS
Near-fatal asthma is a subtype of asthma with unique risk factors and variable presentation that requires early recognition and aggressive intervention.
Restrepo
Ruben D
RD
Department of Respiratory Care, University of Texas Health Science Center, San Antonio 78229, USA. restrepor@uthscsa.edu
Peters
Jay
J
D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D010641:Phenotype; D011379:Prognosis; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D013224:Status Asthmaticus / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy
D018927:Anti-Asthmatic Agents