PSYCHOSOCIAL RISK-FACTORS IN NEAR-FATAL ASTHMA AND IN ASTHMA DEATHS

Background: A description of near-fatal asthma (NFA) and comparison wi th patients who died of asthma in an English health district between 1 988 and 1995. Methods: The hospital case notes of patients aged under 65 years with NFA, identified from the intensive therapy unit register , were reviewed using forms based on those of the East Anglian confide ntial asthma death enquiry. Details were compared with patients dying from asthma in the same population during the same period. Results: Be tween 1988 and 1995, 19 patients suffered 23 episodes of NFA and 44 di ed from asthma. Those with NFA were significantly younger. There were more women in both groups. Two patients with NFA subsequently died of asthma. Significantly more patients with NFA had had a previous NFA ep isode than those who died. Five had a cardio-respiratory arrest. Thirt een required intermittent positive pressure ventilation (IPPV). Paco(2 ) ranged from 6.1 to 17.8 kPa; nine had Paco(2)greater than or equal t o 10 kPa and three recovered without IPPV. Adverse psychological and s ocial factors were similar in both groups. Denial was the commonest ps ychological factor and domestic, financial or employment stress, smoki ng or passive smoking the commonest adverse social factors; only two w ith NFA and seven who died had no recorded adverse psychological or so cial factors. Conclusions: NFA and deaths from asthma occur in asthmat ics who have many psychosocial risk factors in common. Special attenti on needs to be directed at patients with these adverse psychosocial fa ctors, emphasising that they need continued follow-up with support to help them manage their asthma according to currently recommended pract ice.