Risk factors for asthmatic patients requiring intubation: A comprehensive review

During recent decades, asthma prevalence and mortality have increased at rapid rats worldwide among children, teenagers, and young adults. The increased mortality of patients with asthma have mounted significant concerns. Indeed the paradox of improved pharmacotherapy but worsening prognosis has been explored in depth in several studies including observations in epidemiology, access to medical cared and drug toxicity. In the United States, the asthma mortality rate has increased steadily over the past fifteen years and has only recently shown signs of leveling off. It is widely believed, although unproven that many asthma deaths may be preventable. We have addressed one critical factor in severe asthma by attempting a definition of risk factor for intubation using demographic data and a retrospective cohort study of hospitalized asthmatics. This study included all asthmatics aged 5 through 34 years admitted over a 10-year period (1984-1994) to the University of California Davis Medical Center. Nine hundred ninety three such asthma admissions were reviewed, involving 556 females and 437 males, mean age of 19.7 years. Of this group, 284 were White, 459 were Black, 182 were Hispanic, 40 were Asian and 28 were American Indian. By National Heart, Lung, and Blood Institute guidelines, there were 284 mild, 524 moderate and 185 severe cases. Fifty seven asthmatics required intubation for their asthma. The significant risk factors identified for intubation were psychological and psychosocial problems, family dysfunction, low socioeconomic status, little formal education, unemployment, active tobacco smoking and/or second hand smoke exposure, parenteral history of allergy or asthma, atopy, prior intubation, intercurrent respiratory infection, language barrier, crowding, prior asthma emergency room visit in past year, prior asthma hospitalization in past year, and steroid dependence. These risk parameters may be important determinants of baseline risk for asthma deaths and their recognition may have a significant impact on preventive measures.