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a Department
of Respiratory Medicine, Green Lane Hospital, Auckland, New Zealand, b Department of Medicine, University of Auckland, School of
Medicine, Auckland, New Zealand
Correspondence to: Dr J Kolbe, Respiratory Services, Green Lane Hospital, Green Lane West, Auckland 3, New Zealand.
Received 4 August 1997; Returned to authors 8 September 1997; Revised version received 23 December 1997; Accepted for publication 23 December 1997
BACKGROUND
Studies of asthma death and severe life
threatening asthma (SLTA) include reports of patients who had rapid
onset asthma. A study was undertaken to determine the relative
frequency of rapid (<6 hours duration) and slow (
6 hours) onset
attacks in patients admitted to hospital with acute severe asthma, and
to establish whether those with rapid onset asthma differ in terms of
risk factors for asthma morbidity and mortality such as indices of
asthma severity/control, socioeconomic factors, health care, and
psychological factors.
METHODSA cross sectional study was performed on
316 patients aged 15-49 years admitted with acute severe asthma and
interviewed within 24-48 hours of admission.
RESULTSPatients underestimated the duration of
the index attack. Only 27 (8.5%) were classified as rapid onset. There
were more men in the rapid onset group than in the slow onset group
(52% versus 26%), and there was evidence of socioeconomic advantage
in the patients with rapid onset attacks. The rapid onset group had
more previous episodes of SLTA and were more likely to present with SLTA, but there was no difference in length of stay in hospital. The
rapid onset group were less likely to have presented to a GP during the
index attack and were more likely to have used ambulance services.
There was no difference between the groups in any psychological or
health care measure.
CONCLUSIONSRapid onset attacks are an important
but uncommon manifestation of asthma that are more likely to present
with SLTA in patients who are more likely to have had previous SLTA.
Male subjects are at increased risk of rapid onset attacks, and
socioeconomic disadvantage, deficiencies in health care (ongoing and
acute), and psychological factors are no more common in these patients
than in those with attacks of slow onset. These data are consistent
with the hypothesis that there is a small proportion of patients with
rapid onset severe asthma who do not have the usual risk factors
associated with asthma morbidity or mortality, and thus require
different management strategies.
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