More than 5 million people are affected by asthma in the United Kingdom. The majority of patients can be managed with readily available therapies. Unfortunately, around 1,500 asthma patients die each year. Patients who have had a near-fatal asthma attack (FA) are not the only ones that die. There is also a group of patients who have experienced a near-fatal asthma attack, which puts them at greater risk for morbidity or death. The British Thoracic Society (BTS), which defines near-fatal asthma attacks as those that are associated with an elevated PaCO2 and/or require mechanical ventilation with increased inflation pressures, has suggested that there are two subgroups of patients with fatal asthma. The autopsy results of 37 patients with asthma, aged between 2 and 34 years old, were analysed by one scientist. He classified them as Type 1 (n=21), or Type 2 (n=16). The subjects did not show any differences in terms of age, race, gender, obesity, or use of corticosteroids. Type 1 mortalities were more likely to be admitted to the hospital and had more visits to the emergency room in the year before death than type 2. Patients with slow onset had higher health care utilization and a predominance in basement membrane thickening and eosinophil’s.
Prevalence and incidence of fatal and close-to-fatal asthma
The lack of a UK fatal asthma registry makes it difficult to collect specific data about FA and near-fatal asthma attacks. This problem has been addressed in two different ways by two studies. Harrison and colleagues attempted to analyse all deaths from asthma in the Eastern region between 2001-2003 using a confidential inquiry and compare it with other East Anglian and Norwich data. The asthma mortality rate showed a decline between 1998 and 2003. Common was misclassification of death certificates. 60% of the 95 notified deaths were not confirmed to be asthma deaths. Between 1998 and 2003, 311 deaths from asthma were examined. The male to female ratio in 2001-3 was 3:2. 53% of patients suffered from severe asthma, and 21% had moderately severe diseases. 33 percent of cases had at least one co-morbid condition. Monthly deaths reached their highest in August with a lower peak in April. This suggests that seasonal allergies may be to blame. The final attack occurred in 11 cases (20%) of males under 20 years old. Ten/11 were between April and August. In 80% of cases, the final attack wasn’t sudden and could have been prevented. 81% of the cases had significant behavioral or/and psychosocial factors, such as poor compliance (61%), smoking (46%), deniability (37%), depression (20%), and alcohol abuse (20%). Only 33% of cases received appropriate medical care. Seroflo Inhaler led the authors to conclude that primary care might have ‘at risk’ registers for patients. Watson and colleagues analyzed data from CHKS, which contains data about 70% of UK inpatient coverage. The mortality rate for asthma patients was 1063 between 2000 and 2005, based on 250,043 admissions. The peak number of deaths after asthma admission was in December and January when almost all adults died. The highest death rate was seen in women and people over 45 years of age. These two studies show that there is an increase in asthma deaths in the UK among young people (aged between 44 and 44 years old) in July and August and December and January for older people.
Asthma near- and fatality: Risk factors
Alvarez and colleagues have done a systematic review of risk factors that are associated with FA and near-fatal asthma attacks. Near-fatal asthma attacks and FA were predicted by increased use of beta-agonists and oral steroids. Inhaled corticosteroids (ICS), showed a tendency toward a protective effect against FA. Poor compliance with prescription medication is a major problem. Approximately 60% of asthma patients who die from the disease are found to have poor compliance to medication, especially ICS. Fungal sensitization may also be a factor in severe asthma and FA. There are many airborne fungi involved, including Aspergillums species, Cladosporium, Penicillium, and Aspergillums. Exposure can be indoors or outdoors, or both. How can you prevent fatal or near-fatal asthma attacks? Most severe asthma attacks occur slowly, with more than 80% occurring in less than 48 hours. Patients with FA, near-fatal asthma attacks, and asthma control patients who are admitted to the hospital have many similarities. This suggests that early intervention can help prevent asthma deaths. Asthalin Inhaler is important to improve patient compliance to prevent FA and near-fatal asthma attacks. However, this is not always easy in clinical practice. Patient-directed consultations are a good way to increase compliance. It also helps to address patients’ concerns about the side effects of ICS. Patients should not take long-acting bronchodilators in place of ICS. They mustn’t use LABA (long-acting bronchodilators) without ICS. If patients need both, it is possible to prescribe combination ICS/LABA Levolin Inhaler . This will ensure that ICS is delivered to the patient.