[Clinical characteristics of near-fatal asthma attack induced by NSAIDs]

Despite advance in the treatment of asthma, asthma-related deaths have not declined. One of the reasons in those cases may be that there is a surprising lack of information on death from asthma since most of asthma deaths take place outside the hospital. Learning about near-fatal asthma attack (NFA) patients is useful to understand the mechanisms of asthma deaths because NFA patients and fatal asthma possess common clinical characteristics. It is well-known that there are two types of severe asthma exacerbation, that is, "sudden onset" and "slow onset attaches", in terms of clinical, functional and blood gas parameters. On the other hand, NSAIDs is one of the factors leading to exacerbation of asthma or asthma-related death. We examined the characteristics of NSAIDs-induced asthma and the pattern of respiratory arrest in the NSAIDs-induced NFA group compared to non-NSAIDs group at a Kyoto National Hospital from 1986 to 1997. A Total of 30 patients (34 cases) with NSAIDs-induced asthma among 265 admissions with asthma attack were reviewed involving 15 women and 15 men, mean age 46 +/- 14 years old. Six patients (8 cases) of NSAIDs group and 13 patients of non-NSAIDs group had intubation for their NFA. NSAIDs group showed more severe respiratory insufficiency with higher arterial CO2 level compared to non-NSAIDs group (91.5 +/- 16.3 vs 76.3 +/- 17.0 Torr) and significant lower pH level (7.02 +/- 0.14 vs 7.18 +/- 0.07, p < 0.05). But, NSAIDs group showed significantly more short weaning time than that of non-NSAIDs group (p < 0.01). We suggest that many sporadic cases of rapid onset severe asthma attacks may result from the ingestion of NSAIDs.