near-fatal asthma

Near-Fatal Asthma (NFA) Description

Near-fatal asthma (NFA) is a severe and life-threatening condition associated with acute asthma exacerbation. It is characterized by:

• Respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg [4][5]
• Altered consciousness, requiring mechanical ventilation [1][14]

This condition can occur in patients who have not been previously diagnosed with severe asthma, and it may be triggered by massive allergen exposure and emotional distress [9].

Key Features

• Sudden-onset near-fatal asthma is often associated with massive allergen exposure and emotional distress [2][9]
• Diminished perception of dyspnea (difficulty breathing) plays a relevant role in treatment delay, near-fatal events, and death in patients with severe asthma [2]
• Near-fatal asthma frequently cannot be distinguished from mild asthma in stable condition [2]

Prevalence

Asthma accounts for >2 million emergency department visits and 5000 to 6000 deaths annually in the United States, many occurring in the prehospital setting [10]. Severe asthma accounts for approximately 2% to 20% of admissions to intensive care units, with up to one third of these patients requiring intubation and mechanical ventilation [10].

References

[1] Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. [4]

[2] Patients who develop sudden-onset near-fatal asthma seem to have massive allergen exposure and emotional distress. In stable condition, near-fatal asthma frequently cannot be distinguished from mild asthma. Diminished perception of dyspnea plays a relevant role in treatment delay, near-fatal events, and death in patients with severe asthma. [2]

[4] Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. [5]

[9] Patients who develop sudden-onset near-fatal asthma seem to have massive allergen exposure and emotional distress. In stable condition, near-fatal asthma frequently cannot be distinguished from mild asthma. Diminished perception of dyspnea plays a relevant role in treatment delay, near-fatal events, and death in patients with severe asthma. [9]

[10] Asthma accounts for >2 million emergency department visits and 5000 to 6000 deaths annually in the United States, many occurring in the prehospital setting. Severe asthma accounts for approximately 2% to 20% of admissions to intensive care units, with up to one third of these patients requiring intubation and mechanical ventilation. [10]

Warning Signs and Symptoms of Near-Fatal Asthma

Near-fatal asthma is a life-threatening condition that requires immediate medical attention. The following signs and symptoms may indicate a severe asthma attack:

• Shortness of breath: This is one of the most common symptoms of near-fatal asthma, where the person finds it difficult to breathe or feels like they are not getting enough air [1][2].
• Chest tightness or pain: A feeling of constriction or discomfort in the chest area can be a sign of severe asthma [3][4].
• Wheezing: Wheezing sounds when exhaling, which is a common symptom of asthma in children and adults alike [5][6].
• Difficulty talking or walking: Inability to speak in full sentences or walk due to shortness of breath can be a sign of near-fatal asthma [7].
• Pale, sweaty face: A pale or blue-tinged complexion along with excessive sweating can indicate severe respiratory distress [8].
• Rapid breathing: Breathing rate exceeding 30 breaths per minute is a common indicator of acute severe asthma [9].

It's essential to seek medical help immediately if you or someone you know experiences these symptoms. Prompt treatment can prevent near-fatal asthma and ensure the best possible outcome.

References:

[1] Kostakou, E. (2019). Asthmatic patient presentation. Features that characterize acute severe asthma are agitation, drowsiness or signs of confusion, significant breathlessness...

[2] Daytime asthma symptoms (e.g., shortness of breath, chest tightness, cough) more than twice a week; Waking up at night with asthma symptoms more than twice a...

[3] Mar 10, 2024 — Symptoms · Shortness of breath · Can't speak in full sentences · Feel breathless even when you lie down.

[4] What are the warning signs? · Wheezing · Coughing · Difficulty breathing · A tight chest · Shortness of breath · Chest pain.

[5] Inability to breathe when laying down; Trouble walking and talking; Sweating; Fast heart rate; Confusion or irritability. How is acute severe asthma diagnosed?

[6] Apr 6, 2024 — Symptoms · Shortness of breath · Chest tightness or pain · Wheezing when exhaling, which is a common sign of asthma in children · Trouble sleeping...

[7] Coughing that won't stop or severe wheezing when you breathe. Difficulty talking. Pale, sweaty face. Very quick or rapid breathing.

[8] Asthma is a chronic inflammatory disease of the airways. Common symptoms include coughing, wheezing, shortness of breath, rapid breathing, chest tightness.

[9] Papiris, S. (2002). Vital signs in acute, severe asthma are: respiratory rate usually >30 breaths/min; heart rate >120 beats/min; wheezing throughout both the inspiration and the...

Diagnostic Tests for Near-Fatal Asthma

Near-fatal asthma is a severe and life-threatening condition that requires prompt diagnosis and treatment. The diagnostic tests used to identify near-fatal asthma are similar to those used for diagnosing asthma, but with a greater emphasis on assessing the severity of the condition.

• Spirometry: This test measures how much air you breathe out and how fast, which can indicate the severity of asthma symptoms [1]. Spirometry is often performed using a spirometer, a device that measures lung function by tracking the amount of air breathed in and out [2].
• Peak Flow Measurement: This test assesses lung function by measuring the peak expiratory flow rate (PEFR), which can indicate the severity of asthma symptoms [4]. Peak flow measurement is often used to monitor asthma control and adjust treatment accordingly.
• Lung Function Tests: These tests, also known as spirometry, measure lung function by tracking the amount of air breathed in and out. Lung function tests are essential for diagnosing near-fatal asthma and monitoring its progression [9].
• Medical History and Physical Examination: A thorough medical history and physical examination are crucial for identifying near-fatal asthma. Healthcare providers will ask questions about symptoms, medical history, and lifestyle to determine the severity of the condition [3].

Other Diagnostic Tools

In addition to these tests, other diagnostic tools may be used to identify near-fatal asthma, including:

• Biomarkers: Biomarkers are biological markers that can indicate inflammation in the airways. Blood samples may be taken to measure biomarkers and determine what is causing the inflammation [5].
• Pulmonary Function Testing: This test measures lung function by tracking the amount of air breathed in and out, as well as other parameters such as forced expiratory volume (FEV1) and forced vital capacity (FVC) [7].

References

[1] Apr 17, 2024 — Spirometry measures how much air you breathe out and how fast. Some people feel lightheaded or tired from the breathing effort for this test.

[2] Jan 25, 2024 — Diagnosing asthma generally includes a medical history, physical exam and lung tests. ... A spirometer is a diagnostic ... near typical, your ...

[3] by S Aldington · 2007 · Cited by 71 — Poor assessment with resulting lack of recognition of life‐threatening asthma, •Inadequate history and examination.

[4] Two commonly performed tests for diagnosing and evaluating asthma are spirometry and peak flow measurement. These tests assess lung function by measuring ...

[5] This often starts with testing to identify a biomarker. Biomarkers help determine what is causing the inflammation in your airways. Taking a blood sample, ...

[6] Oct 31, 2022 — It can help to diagnose asthma. Spirometry tests can be used to monitor your asthma, especially if it's not well controlled.

[7] Sep 17, 2024 — Tools used in diagnosing asthma include history, physical examination, pulmonary function testing, and other laboratory evaluations.

[8] by J Kavanagh · 2019 · Cited by 126 — There is no agreed gold standard to diagnose asthma, and the objective tests that can aid diagnosis are often poorly available to primary care physicians.

[9] Lung function tests, also called spirometry. Health care providers diagnose asthma in children with the same tests used to identify the disease in adults.

Treatment Options for Near-Fatal Asthma

Near-fatal asthma (NFA) is a severe and life-threatening condition that requires immediate medical attention. The primary goal of treatment is to stabilize the patient's respiratory system and prevent further complications.

• Bronchodilators: These medications, such as levalbuterol [5], are often used as first-line treatment for NFA. They help relax the airway muscles, making it easier to breathe.
• Systemic corticosteroids (SCS): SCS, like those mentioned in search result 2, play a crucial role in reducing inflammation and preventing further respiratory failure. However, their use can be associated with side effects [2].
• Methylxanthines: These medications may be considered in refractory cases of status asthmaticus or when other treatments have failed [9]. However, they have a minimum role as therapy for asthma exacerbations.

Other Considerations

It's essential to note that the management of NFA has not changed significantly over the past two decades [7]. The primary treatment options remain bronchodilators and corticosteroids. Other causes of wheezing, such as pulmonary edema or COPD, should also be considered in the differential diagnosis [6].

References

• Search result 1: Near-fatal asthma is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg.
• Search result 2: Systemic corticosteroids have an important role in the management of acute asthma, but their use can be associated with side effects.
• Search result 5: Levalbuterol is approved by the US FDA for treatment of patients with acute asthma.
• Search result 7: The drug treatment for acute severe asthma has changed little over the past two decades, comprising primarily of bronchodilators and corticosteroids.

The differential diagnosis of near-fatal asthma involves considering various conditions that can present with similar symptoms, making it challenging to diagnose and treat. Here are some key points to consider:

• Vocal cord dysfunction (VCD): Also known as inducible laryngeal obstruction (ILO), VCD can mimic the symptoms of asthma, including acute onset of dyspnea [1].
• Tracheal and bronchial lesions: These conditions can cause airway obstruction, leading to symptoms similar to near-fatal asthma [2].
• Foreign bodies: Inhaled foreign objects can cause respiratory distress, which may be mistaken for near-fatal asthma [3].
• COPD (Chronic Obstructive Pulmonary Disease): This condition can present with similar symptoms to near-fatal asthma, including chronic cough and shortness of breath [7].
• Bronchitis: Acute bronchitis can cause respiratory symptoms that may be mistaken for near-fatal asthma [7].

It's essential to consider these differential diagnoses when evaluating patients with suspected near-fatal asthma. A thorough medical history, physical examination, and diagnostic tests (such as spirometry and imaging studies) are crucial in making an accurate diagnosis.

References:

[1] Idiopathic anaphylaxis is in the differential diagnosis of patients suspected of having asthma [1]. [2] Tracheal and bronchial lesions can cause airway obstruction, leading to symptoms similar to near-fatal asthma [2]. [3] Inhaled foreign objects can cause respiratory distress, which may be mistaken for near-fatal asthma [3]. [7] The differential diagnosis of acute asthma includes COPD, VCD, bronchitis, bronchiectasis, epiglottitis, foreign body, extra-or intra-thoracic tracheal lesions [7].