[Severe forms of effort-induced asthma]

Severe reactions in exercise-induced asthma (EIA) seem to be underestimated in the published literature. We report two cases of near-miss death from EIA that occurred after a short run. We review 364 exercise tests that were performed between September 1987 and October 1988 by a standardised protocol on a treadmill, on patients with possible EIA. A positive test, defined by a fall of FEV1 of at least 20% was found in 173 patients. From 21 patients with a fall of greater than 50%, 4 presented severe signs of: Cyanosis. Intense dyspnea with impediment of speech. General malaise with hypertension. These 4 patients were not greatly different from patients of the 50% fall group when compared for FEV1 before the test and for heart-rate during the test. They differed in the duration of the asthma attack, which was more protracted, despite the use of beta-2 agonists. The onset of severe reactions is 2.3% of positive tests and seems to be unpredictable.