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.
Department of Respiratory Care, University of Texas Health Science Center, San Antonio 78229, USA. restrepor@uthscsa.edu
Ruben D
RD
Restrepo
Jay
J
Peters
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