The fatality-prone asthmatic patient. Follow-up study after near-fatal attacks

We studied 12 fatality-prone patients for 18 months after they had been discharged from the hospital following life-threatening exacerbations of asthma (mean PaCO2 on admission, 97 mm Hg). Our objectives were (1) to evaluate the natural history of their disease during ambulatory care and (2) to investigate whether close follow-up might help to avert further near-fatal events. Only seven of the 12 patients consented to be enrolled in the study, which included monthly scheduled visits to the hospital and monthly telephone calls to record emergency room visits and changes in therapy. By the conclusion of the 18-month follow-up period, two of the noncompliant patients had died during asthmatic attacks. By contrast, all of the seven who had agreed to participate survived; one required intubation and mechanical ventilation, and the other six required occasional unscheduled emergency room visits because of acute exacerbations. Specific precipitants could not be determined, and the most common cause of the acute episodes was likely inadequate steroid therapy. The results suggest that compliance with adequate antiasthmatic therapy and close follow-up may be important in the prevention of near-fatal events.