ABSTRACT

Background: The life-threatening asthma is the most serious clinical expression of asthma, even though the risk factors associated with its occurrence have been incompletely characterized. Objective: To determine the association of life-threatening asthma with environmental, occupational and patients exposures obtained from a standardized questionnaire in a national referral hospital for respiratory diseases. Material and methods: We performed a case-control study (hospital-based) at the National Institute of Respiratory Diseases Ismael Cosio Villegas for the period 2004-2009. Cases were patients with life-threatening asthma defined as: patients with acute asthma who came from the intensive care or intubation died, or did hypercapnia. antiretroviral crisis was defined as: a) hypercapnia (PaCO2 › 6.65 KPa (50 mm/Hg) and/or acidosis with pH ‹ 7.30; b) cardiac arrest; c) the need for intubation and ventilator management, d) stay in a unit intensive care unit, e)death. The diagnosis of acute asthma was accepted if it was described in the file of each patient. We randomly selected two control groups: Group 1 patients otolaryngology, but without lung disease and control. Group 2 patients with non life-threatening asthma. Cases and controls were matched for age and sex. The protocol was approved by the Committee on Science and Bioethics National Institute of Respiratory Diseases (approval number C17-08). Results: We compared 50 patients with life-threatening asthma with 48 controls with non life-threatening asthma and 96 otolaryngology controls. In multivariate analysis, patients with life-threatening asthma, in comparison with otolaryngology controls showed higher consumption of tobacco (OR = 3.4 [95% CI 1.1-11.2], p = 0.04); alcohol (OR = 6.0, [95% CI 1.5-24.4], p = 0.01); have carpet in the bedroom (OR = 15.2 [95% CI 2.6-89], p = 0.003) and to have birds at home (OR = 3.1 [95% CI 1.1-9.1], p = 0.03) after control for the presence of cats and indoor air pollution. When comparing patients with and without fatal asthma and otolaryngology controls we found no significant differences in the risk factors analyzed. Regarding the entry treatment, only 53% of asthma cases with RV were treated with inhaled steroid. Six of 60 patients with ARV (10%) could be successfully treated with noninvasive ventilation. Conclusions: The ARV patients showed a higher frequency of risk factors such as exposure to smoking, alcohol, pets and carpets compared to controls ORL. When comparing patients with and without asthma risk vital, this study found no association between exposure to environmental factors and an increased risk of developing fatal asthma. Only 53% of patients were ARV treatment with inhaled steroids, reflecting the low utilization the same in patients with severe asthma and in our series, 10% of patients were successfully treated with NIV.

KEYWORDS

Near fatal asthma, mortality, hospitalization, life-threatening asthma.

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