MALIGNANT POTENTIALLY FATAL ASTHMA - ACHIEVEMENT OF REMISSION AND THEAPPLICATION OF AN ASTHMA SEVERITY INDEX

Patients fulfilling diagnostic criteria for malignant potentially fata l asthma require aggressive involvement by the physician to prevent av oidable fatalities from asthma. Efforts to overcome barriers to treatm ent caused by noncompliance are critical to successful care. This repo rt reviews five patients with malignant potentially fatal asthma in re mission, in whom noncompliance played the major role in preventing con trol of asthma. Through patient confrontation and the monitoring of se rum concentrations of prednisone and its metabolite prednisolone, nonc ompliance may be addressed. Psychiatric referral may also be of benefi t, if accepted by the patient and family Use of injectable methylpredn isolone may be a necessary alternative to prevent life-threatening com plications of asthma. In all patients, keeping medical regimens as sim ple as possible is advocated, with the use of the lowest doses of medi cation necessary to maintain the control of symptoms, and the preventi on of morbidity and mortality. An asthma severity index for the illust ration of longitudinal disease severity is applied to these patients.