title: Characteristics and prognosis of near-fatal asthma exacerbations.
abstract: BACKGROUND
  Asthma remains a major public health concern because of its high prevalence and the costs it generates. Near-fatal asthma (NFA) episodes represent the most severe forms of the disease after fatal asthma with significant variations in their incidence between different populations.
  
  
  OBJECTIVE
  To analyze the episodes of NFA over a period of 11 years in the hospital.
  
  
  METHODS
  The authors retrospectively reviewed all admissions due to asthma exacerbation in our hospital between 2000 and 2010 for patients over 18 years of age.
  
  
  RESULTS
  The study included 400 NFA episodes of 285 patients (74% women; mean age 66 years). Of these patients, 228 (80%) had a single episode of NFA and 57 had more than 1 episode during the study period. The authors observed no clear upward or downward trend during the study period. Readmitted patients had more comorbidities, poorer lung function, more severe forms of asthma and more admissions in the year before the index admission. There was a mortality rate of 3.1%. More than 20% of patients were not given controller treatment and more than 40% of patients were not treated with inhaled corticosteroids (ICS).
  
  
  CONCLUSIONS
  NFA episodes are still prevalent in the population of patients with asthma. Reasons for this could be related to improper management in the stable phase, as suggested by the low rate of patients treated with ICS. It also seems necessary to optimize patient management during hospitalization because stays appear prolonged in comparison with studies in other countries.
authors.affiliation: Department of Medicine (F-JG-B, LV-C, AP-R), University of Santiago de Compostela; Spanish Biomedical Research Networking Centre (CIBERES) (F-JG-B, XM); Department of Respiratory Medicine (F-JG-B, NG-C, LV-C), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS) (F-JG-B, LV-C); Department of Respiratory Medicine (UC-A), Hospital of El Ferrol; Department of Emergency (M-TG-S), Hospital do Salnes; Department of Respiratory Diseases (AB), Hôpital Arnaud de Villeneuve of Montpellier; Department of Internal Medicine (AP-R), University Hospital of Santiago de Compostela; Department of Radiology (J-MC), University of Santiago de Compostela; Department of Pediatrics (J-DM-G), University Hospital of Santiago de Compostela; Department of Medicine (XM), University Autònoma of Barcelona; and Department of Respiratory Medicine (XM), Hospital Vall d'Hebron.
authors.forename: Francisco-Javier
authors.initials: FJ
authors.lastname: Gonzalez-Barcala
authors.forename: Uxio
authors.initials: U
authors.lastname: Calvo-Alvarez
authors.forename: Maria-Teresa
authors.initials: MT
authors.lastname: Garcia-Sanz
authors.forename: Arnand
authors.initials: A
authors.lastname: Bourdin
authors.forename: Antonio
authors.initials: A
authors.lastname: Pose-Reino
authors.forename: Jose-Martin
authors.initials: JM
authors.lastname: Carreira
authors.forename: Jose-Domingo
authors.initials: JD
authors.lastname: Moure-Gonzalez
authors.forename: Nuria
authors.initials: N
authors.lastname: Garcia-Couceiro
authors.forename: Luis
authors.initials: L
authors.lastname: Valdes-Cuadrado
authors.forename: Xavier
authors.initials: X
authors.lastname: Muñoz
mesh_terms: D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012621:Seasons