Near-fatal asthma: a population-based study of risk factors

BACKGROUND: The study of near-fatal asthma (NFA) may provide a means to further our understanding of fatal asthma. Studies of NFA often are derived from a single ICU rather than from a defined population. We therefore aimed to identify factors distinguishing NFA patients (cases) from those persons treated in an emergency department (ED) ED control subjects] and in the community (community control subjects CCs]). METHODS: This was a population-based case-control study conducted over 20 months of 45 NFA patients (age range, 5 to 50 years), 197 ED control subjects treated in an ED, and 303 CCs, all of whom were residents of Alberta. RESULTS: The age distribution was similar between NFA patients and control subjects, with the majority being < 22 years of age (NFA patients, 68.9%; ED control subjects, 71.3%; CCs, 60.7%). Those patients with NFA were significantly more likely to have received a diagnosis before 5 years of age (66.6%), compared to ED control subjects (39.6%) and CCs (28.7%). The NFA group was significantly more likely to report moderate-to-severe disease and more frequent symptoms than the other groups. Therapy with bronchodilators was used most frequently by the NFA group compared to the ED control subjects and CCs (p < 0.001), as was therapy with inhaled steroids (p < 0.001) and oral steroids (p < 0.001). NFA patients had higher scores for vulnerability and were most likely to admit to stress as an asthma trigger. All groups had high exposure to cigarette smoke and pets. CONCLUSION: NFA patients have many modifiable risk factors and many similarities to ED control subjects and CCs with asthma. General measures to improve asthma control and awareness of risks are required in all groups.