[Fatal attack in patients with bronchial asthma]

What is most notable about asthma deaths is that they continue to occur despite increased understanding of the pathophysiology of asthma, more effective treatment and improvements in asthma education. Studies of fatal and near fatal asthma revealed two distinct groups of patients. The first is a "slow onset-late arrival" group (type I) in whom the final common pathway is a period of poor asthma control, increased use of bronchodilators, late arrival for care of the final attack and underutilization of glucocorticosteroids. This group of patients is characterized by the presence of eosinophilia in the airways. The second group (type II), includes only the minority of death cases. These patients have a sudden, unexpected and rapidly progressive attack. This group of patients is characterized by the presence of neutrophilia in the airways. Two cases of death due to asthma attach, one presenting type I patients and the second type II patients, are described.