The Science Journal of the American Association for Respiratory Care
Problem statement: Asthma mortality is excessive and may be reducible. Behavioral risk factors for asthma death are difficult to identify, and are often too nonspecific to be of predictive value.
Methods: A case-control study of 19 cases with near-fatal asthma who were matched for gender, age, asthma treatment and severity to 19 controls was used to examine behavioral, historical and symptomatic risk factors of near-fatal asthma. Subjects were a sample of all non-military, near-fatal asthma cases on the Island of Oahu, Hawaii. Age limits were 18 - 46 years. A professional interviewer administered three previously validated questionnaires, respiratory disease symptoms and history, psychological symptoms and social support. Both the interviewer and subjects were blinded to the subject's status as case or control.
Results: Major findings include severe asthmatic controls under medicating compared to near-fatal asthma cases, and that they were otherwise very similar. As a study group the subjects (cases and controls) were more often low income, psychologically distressed, female and of Hawaiian ethnicity who are seeing a physician pulmonary specialist and being prescribed appropriate medications. Medication compliance was poor. Sixty percent of the subjects had at least one parent with asthma. Mean duration of asthma was 21.5 years. There was a very high (>16%) mortality rate among potential near-fatal asthma subjects. Discussion: These data suggest that restraint in anti-asthma medication use may protect severe asthma patients from near-fatal attacks. These data confirm the similarity of subjects with near-fatal asthma and severe asthma.