Fatal and near-fatal asthma questionnaire: Prelude to a national registry

Background: Asthma mortality rates continue to be unacceptably high in the United States. As a follow-up to the initiatives proposed by the Asthma Mor tality Task Force in 1987, the Committee on Asthma Mortality of the America n Academy of Allergy, Asthma, and Immunology developed a questionnaire on f atal and near-fatal asthma, Objective: This study assessed completeness of answers from participating p hysicians and described characteristics of patients with fatal and near-fat al asthma, Methods: There were 111 survey items intended to characterize patients with fatal or near-fatal exacerbations of asthma, The questionnaire was sent to the members of the American Academy of Allergy, Asthma, and Immunology (ap proximately 3900), and a total of 143 usable questionnaires were received. Results: Responding physicians had information on most items in the questio nnaire; the mean number of responses was 120 of 143 possible, with a median of 128 and a range of 40 to 143, Patient demographics, description of the event, identification of overall risk for the event, use of medications, ac id characteristics of asthma management had the most complete responses (me dian response rates were 126-143), Presence of factors contributing to the event had fewer responses (range, 44-125), The physicians frequently had in formation on some psychologic characteristics (eg, 108 responses for depres sion and/or hopelessness and 127 responses for social support) but less inf ormation on several others (eg, 62 responses for family dysfunction). Stati stical analysis of the completed surveys indicated that only 2 characterist ics distinguished fatal from near-fatal asthma: progression in minutes (adj usted odds ratio, 4.89; 95% confidence interval, 2.05-12.90) and absence of a past history of intubation (adjusted odds ratio, 3.55; 95% confidence in terval, 1.55-8.97), Conclusions: There is a need to gather further data on patients with fatal and near-fatal events to design appropriate prospective studies on asthma m orbidity and mortality rates. Physicians can contribute important informati on about these patients. Gathering such data would be enhanced by establish ing a national registry on fatal and near-fatal asthma.