Gn. Richards et al., DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SEVERE LIFE-THREATENING ASTHMA - COMPARISON WITH ASTHMA DEATHS, Thorax, 48(11), 1993, pp. 1105-1109
Background-Studies of mortality from asthma have suggested that a very
severe asthma attack identifies a group at greatly increased risk of
subsequent death from the disease. This study compares the demographic
characteristics of asthmatic patients who required management in an i
ntensive care unit for a severe life threatening attack between 1981 a
nd 1987 with a group who died of asthma between 1980 and 1986. The out
come of the group admitted to an intensive care unit is described. Met
hods-The groups comprised all cases aged between 15 and 49 years arisi
ng from the Auckland Area Health Board (AAHB) population who required
admission to an intensive care unit for asthma between 1981 and 1987 (
n = 413) and all deaths from asthma in those aged 15 to 49 years arisi
ng from the New Zealand population between 1980 and 1986 (n = 466). De
tails of age, sex, and information on the day and month of the attack
were collected. For the group requiring admission to an intensive care
unit, outcome in terms of mortality and readmission to intensive care
was determined. Results-The age distributions of the two groups were
dissimilar, with the severe life threatening attack group having an ex
cess of asthmatic patients under 30 years old. The distribution of eve
nts by calendar month was uniform in both groups, but there was an une
xpected increase in frequency of attacks on Sundays in both groups. Ov
er the study period, mortality fell from 5.3 per 100 000 to 3.5 per 10
0 000 but the admission rate to intensive care increased from 10.8 per
100 000 to 17.9 per 100 000. At least 24% of asthma deaths occurring
in the AAHB region during the study period had previously experienced
a severe life threatening attack. Conclusions-The similarities between
the groups suggest that asthmatic patients who experience severe life
threatening attacks are likely to come from the same subgroup of the
asthma population as those who die. The group who experience severe li
fe threatening attacks are at high risk of subsequent morbidity and mo
rtality and further studies may produce information relevant to reduci
ng mortality from asthma.