Risk factors, management and outcomes of patients admitted with near fatal asthma to a tertiary care hospital in Riyadh

Al‐Dorzi, Hasan M.; Alshammary, Haifa; Tamim, Hani; Shammout, Khaled; Dawood, Abdulaziz Al; Arabi, Yaseen M.

doi:10.4103/1817-1737.124441

Cited by 17 publications

(23 citation statements)

References 35 publications

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“…Atopy and/or Immunoglobulin E (IgE) and smoking status were the most commonly assessed risk factors (11 of 13 studies) . This was followed by BMI and drug sensitivity .…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-six studies were included, they were heterogeneous in their design and research questions. We allocated the studies into three groups based on their design: Group 1 'cohort studies/cross-sectional studies' (13 studies), [21][22][23][24][25][26][27][28][29][30][31][32][33][34] which included those that used MDA to examine the prevalence of co-morbidities and risk factors among selected groups of patients with severe asthma. Also included in this group were studies that used baseline variables to predict outcomes, such as exacerbations.…”

Section: Study Typesmentioning

confidence: 99%

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Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

et al. 2017

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The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma-related outcomes. We identified 26 studies and classified these based on study type (cohort/cross-sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co-morbidities and risk factors). The airway domain had the largest number of traits assessed (mean AE SD = 4.2 AE 1.7) compared with co-morbidities (3.6 AE 2.2) and risk factors (3.9 AE 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co-morbidities were psychological dysfunction, sinusitis (both 73%) and gastro-oesophageal reflux disease (GORD; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma-related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.

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“…Atopy and/or Immunoglobulin E (IgE) and smoking status were the most commonly assessed risk factors (11 of 13 studies) . This was followed by BMI and drug sensitivity .…”

Section: Resultsmentioning

confidence: 99%

Section: Study Typesmentioning

confidence: 99%

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

et al. 2017

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“…These patients, who can be classified as severe asthmatics according to the European Respiratory Society (ERS) Guidelines [32], indirectly confirm that severe asthma exacerbations remain a robust predictive risk factor for asthma mortality [33–35]. In the other patients the identification of the level of asthma severity is not easy.…”

Section: Discussionmentioning

confidence: 98%

“…Moreover the underuse of ICS in comparison with SABA, confirmed by the GPs prescription in seven cases, suggests a low adherence to the anti-inflammatory treatment. Recently in patients with mild asthma the excessive use of SABA was identified as a reliable marker of poor control and increased risk of severe exacerbation [33, 34]. The over-prescription of SABA and the under-prescription of preventer medication have been described as a key finding of the UK National Review of Asthma Deaths [35].…”

Section: Discussionmentioning

confidence: 99%

Fatal asthma; is it still an epidemic?

Vianello

Caminati

Crivellaro

et al. 2016

World Allergy Organization Journal

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BackgroundAsthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors.MethodsA web search including key words related to fatal asthma in Italy between 2013 and 2015 has been performed. Concerning the cases that occurred in Veneto, subjects’ clinical records have been evaluated and details about concomitant weather conditions, pollutants and pollen count have been collected.ResultsTwenty-three cases of asthma deaths were found in Italy; 16 of them (69%) occurred in the Veneto Region. A prevalence of male and young age was observed. Most of patients were atopic, died in the night-time hours and during the weekends. The possible risk factors identified were the sensitization to alternaria, previous near fatal asthma attacks and the incorrect treatment of the disease. Weather condition did not appear to be related to the fatal exacerbations, whereas among the pollutants only ozone was detected over the accepted limits. Smoking habits, possible drug abuse and concomitant complementary therapies might be regarded as further risk factors.DiscussionAlthough not free from potential biases, our web search and further investigations highlight an increasing asthma mortality trend, similarly to what other observatories report. The analysis of available clinical data suggests that the lack of treatment more than a severe asthma phenotype characterizes the fatal events.ConclusionsAsthma mortality still represents a critical issue in the management of the disease, particularly in youngsters. Once more the inadequate treatment and the lack of adherence seem to be not only related to the uncontrolled asthma but also to asthma mortality.

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“…The absence of a regular anti-inflammatory treatment has been described in literature as the result of both poor adherence and, in some cases, inappropriate prescription (32). However, the overuse of SABA has been identified as a risk factor not only for severe exacerbations, but also for fatal asthma attacks (33,34). The UK National Review of Asthma Deaths (32) and a recently published Italian fatal asthma case series (35) described the use of SABA alone as a key recurrent finding.…”

Section: Discussionmentioning

confidence: 99%