A community-based study of near-fatal asthma

Background: The purpose of this study was to describe the community-based i mpact of near-fatal asthma within the District of Columbia (Washington, DC) . Methods: The design was a prospective cohort study. Subjects included all p ersons in 1993 who presented to Washington, DC hospitals alive, requiring i ntubation for respiratory failure (including subjects who subsequently died in the hospital). Washington, DC hospitals were contacted on a biweekly ba sis to identify subjects. Patients were contacted by mail, followed by an i nterview with the subject or proxy. Results: Of the 35 case subjects identified, 31 (88.6%) were interviewed. S ixty-one percent of the subjects were female; 84% were African-American; an d 45.2% were less than 18 years old. Forty-five percent had asthma for 10 o r moro years. Twenty-three percent reported the emergency department as the ir usual source of health care, and 32% saw a provider on a weekly basis. F ifty-two percent were taking four or more prescription medications, and 29% were taking no antiinflammatory medications. In the 24 hours before the ev ent, 77% reported difficulty breathing, but only 64% reported contacting a health carl provider. Conclusions: Community-based investigation of near-fatal asthma may lead to a better characterization of risk factors associated with this event. Find ings from this study suggest that some of the factors associated with near- fatal events may be different from those associated with fatal asthma and t hat up to one third of the events may have been preventable.