Case-control study of severe life threatening asthma (SLTA) in adults: psychological factors

Kolbe, John; Fergusson, Wendy; Vamos, Marina; Garrett, Jeffrey

doi:10.1136/thorax.57.4.317

Cited by 85 publications

(78 citation statements)

References 46 publications

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“…The data were analyzed by separating NFA and FA to see if differences existed between the two entities; however, no differences were detected (data not shown). This finding was consistent with current ideas surrounding the issue of NFA and FA being a continuous spectrum of the same entity (10,11). Risk factors that were identified included medications, asthma history, atopy and smoking history.…”

Section: Resultssupporting

confidence: 78%

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A Systematic Review of Risk Factors Associated with Near‐Fatal and Fatal Asthma

Alvarez

Schulzer²,

Young³

et al. 2005

Canadian Respiratory Journal

119

100

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BACKGROUND: Asthma mortality and morbidity continue to be a serious global problem. Systematic reviews provide an opportunity to review risk factors in detail. OBJECTIVE: To review all of the literature for risk factors associated with near-fatal asthma (NFA) and fatal asthma (FA). METHODS: A literature search from 1960 to January 2004 in MEDLINE and EMBASE was conducted. Studies were included based on the following criteria: NFA was defined as an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a partial pressure of CO 2 of at least 45 mmHg or asthma resulting in death (FA); the study reported the number of cases (NFA and/or FA) and asthmatic controls; there was explicit reporting of risk factors; cases that were adult and pediatric in nature; and all study types. Studies that included patients with chronic obstructive pulmonary disease were excluded. RESULTS: Four hundred and three articles were identified, of which 27 met the inclusion criteria. Increased use of medications such as betaagonists via metered dose inhalers (OR=1.67, 95% CI 0.99 to 2.84, P=0.057) and nebulizers (OR=2.45, 95% CI 1.52 to 3.93, P=0.0002), oral steroids (OR=2.71, 95% CI 1.34 to 5.51, P=0.006) and oral theophylline (OR=2.02, 95% CI 1.03 to 3.98, P=0.04) and a history of hospital (OR=2.62, 95% CI 1.04 to 6.58, P=0.04) and/or intensive care unit (OR=5.14, 95% CI 1.91 to 13.86, P=0.001) admissions and mechanical ventilation (OR=6.69, 95% CI 2.80 to 15.97, P=0.0001) due to asthma were predictors of NFA and FA. Prior emergency department assessment did not confer a greater risk of NFA and FA (OR=1.13, 95% CI 0.43 to 2.92, P=0.810).The use of inhaled corticosteroids (ICS) measured in a dose-independent fashion (did the patient take ICS previously; yes or no) inferred equivocal risk of NFA and FA (OR=1.31, 95% CI 0.83 to 2.05, P=0.25). However, two studies measured the use of ICS in a dose-dependent fashion (ie, measured the number of prescriptions filled within the previous six to 12 months). Both studies showed a trend toward a protective effect against FA. One study showed that the premature cessation of ICS can hasten death. CONCLUSIONS: In the present study, risk factors of NFA and FA have been more accurately defined. Clinicians should identify patients with these characteristics to reduce their risk of NFA and FA. Further research should focus on quantifying the impact of risk factors on asthma deaths.

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Section: Resultssupporting

confidence: 78%

“…NFA and FA subjects were presumed to be part of the same pathophysiological spectrum (10,11). The diagnosis of asthma was defined according to the criteria of the American Thoracic Society (12).…”

Section: Preset Definitionsmentioning

confidence: 99%

A Systematic Review of Risk Factors Associated with Near‐Fatal and Fatal Asthma

Alvarez

Schulzer²,

Young³

et al. 2005

Canadian Respiratory Journal

119

100

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“…It seems that latent COPD did not significantly interfere with the results. Our results give support to earlier reports [5][6][7][8][9].…”

Section: Discussionsupporting

confidence: 93%

“…Inhaled corticosteroids play a major part in this [1,2], but environmental circumstances [3,4], smoking [5,6] and psychosocial and emotional factors [7][8][9] may also have an effect on the frequency of symptoms.…”

Section: Introductionmentioning

confidence: 99%

What lies behind relief and worsening of asthma symptoms? A register-based study of adults with asthma and other chronic obstructive pulmonary diseases in Finland

Ikäheimo

Hartikainen

Tuuponen

et al. 2006

Primary Care Respiratory Journal

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SummaryAims: To examine how subjects with relief or worsening of asthma symptoms differ in terms of gender, age, severity and duration of asthma, comorbidity, and difficulties with medication and daily life. Methods: A postal inquiry among a sample of 6000 adults with clinically diagnosed asthma and/or other chronic obstructive pulmonary diseases. Results: Relief of asthma symptoms over a 12-month period was associated with a recent asthma diagnosis, within five years, in both sexes. Lack of current smoking and lack of problems in using anti-asthmatic treatment were associated with a positive outcome in men, and mild asthma and living alone associated with a positive outcome in women. Severe and moderate asthma predicted worse symptoms in both sexes, as did other obstructive pulmonary diseases, living alone, and medication problems amongst men. Conclusions: Patients with asthma should be cared for comprehensively, requiring consideration of both clinical and psychosocial factors that can modify the course of the disease.

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“…Only two potential participants declined. The mean age was consistent with other asthma studies [22,23,27].…”

Section: Study Populationsupporting

confidence: 79%

Standardversuspatient-centred asthma education in the emergency department: a randomised study

Smith

Mitchell²,

Bowler³

2008

Eur Respir J

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High re-attendance rates are common after asthma emergency department (ED) care. Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain. The present study aimed to compare the effectiveness of patient-centred education (PCE) and standard asthma patient education on ED re-attendance.A randomised controlled trial was conducted at two inner-city Australian teaching hospitals' EDs, where patients received either standard patient education (SPE) or PCE. Both groups received a six-topic curriculum. However, PCE patients reordered the topics according to their own priority and thus controlled the order of education.In total, 146 adult patients presenting to EDs with acute asthma were enrolled. After 4 months, ED re-attendance decreased from 22 to 12% in the PCE group and remained unchanged in the SPE group (between group odds ratio 0.4, 95% confidence interval (0.2-1.1)). In 78 patients discharged after ED care, the PCE group had fewer re-attendances after 4 and 12 months (0.3 (0.1-0.9) and 0.3 (0.1-0.8), respectively ). PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months (0.1 (0.0-0.7) and 0.2 (0.0-0.6), respectively). A trend of better asthma control was evident, with a reduction in activity limitation.In conclusion, patient-centred education offers promise as a brief education process in the emergency department. However, a large multicentre trial of patient-centred education is required.

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Case-control study of severe life threatening asthma (SLTA) in adults: psychological factors

Cited by 85 publications

References 46 publications

A Systematic Review of Risk Factors Associated with Near‐Fatal and Fatal Asthma

A Systematic Review of Risk Factors Associated with Near‐Fatal and Fatal Asthma

What lies behind relief and worsening of asthma symptoms? A register-based study of adults with asthma and other chronic obstructive pulmonary diseases in Finland

Standardversuspatient-centred asthma education in the emergency department: a randomised study

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