중증 천식발작 회복 후 임상경과 - 제2보
Clinical Outcomes after Recovery from Severe Asthma Exacerbation - the Second Report
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Background: Approximately 10% of patients with near- fatal asthma (NFA) die within a year of an attack, and close follow-up is helpful to prevent fatal events. Objective: To investigate the clinical outcomes of acute severe asthma and whether close follow-up may help to improve clinical outcomes. Method: Asthma patients (N=225), who were hospitalized due to severe exacerbation during the period 1998∼2006, were followed up using questionnaires or phone interviews. The 146 patients, who had regularly visited our hospital until the examination, were assigned as regular hospital visitor. Result: Twenty-two (9.8%) of the total patients and 7 (15.9%) of 44 NFA patients died (mean follow-up period:138.9 weeks). The mortality rate was significantly lower in regular hospital visitors than in the others (total: 6.2% vs. 16.5%, P＜0.05; NFA: 3.4% vs. 40.0%, P＜0.01). The regular hospital visitors controlled their asthma better (controlled/partly controlled/uncontrolled: 75/38/33 vs. 20/ 28/31; P＜0.001), had better knowledge of asthma (9.7± 0.2 vs. 8.5±0.3, P＜0.01) and used inhaled steroid more frequently (74.7% vs. 55.7%, P＜0.001) than the others. Conclusion: Not a few patients with acute severe asthma die after discharge from hospital. However, close follow-up and adequate asthma control seem to help in the reduction of asthma mortality.
Abstract
Background: Approximately 10% of patients with near- fatal asthma (NFA) die within a year of an attack, and close follow-up is helpful to prevent fatal events. Objective: To investigate the clinical outcomes of acute severe asthma and whether close follow-up may help to improve clinical outcomes. Method: Asthma patients (N=225), who were hospitalized due to severe exacerbation during the period 1998∼2006, were followed up using questionnaires or phone interviews. The 146 patients, who had regularly visited our hospital until the examination, were assigned as regular hospital visitor. Result: Twenty-two (9.8%) of the total patients and 7 (15.9%) of 44 NFA patients died (mean follow-up period:138.9 weeks). The mortality rate was significantly lower in regular hospital visitors than in the others (total: 6.2% vs. 16.5%, P＜0.05; NFA: 3.4% vs. 40.0%, P＜0.01). The regular hospital visitors controlled their asthma better (controlled/partly controlled/uncontrolled: 75/38/33 vs. 20/ 28/31; P＜0.001), had better knowledge of asthma (9.7± 0.2 vs. 8.5±0.3, P＜0.01) and used inhaled steroid more frequently (74.7% vs. 55.7%, P＜0.001) than the others. Conclusion: Not a few patients with acute severe asthma die after discharge from hospital. However, close follow-up and adequate asthma control seem to help in the reduction of asthma mortality.
참고문헌 (23)
- Marquette CH, "A 6-year follow up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma", Am Rev Respir Dis, 146, pp.76~ (1992)
- Molfino NA, "Near-fatal asthma", Eur Respir J, 7, pp.981~990 (1994)
- Kang KW, "Blunted dyspnea perception in severe asthmatics", J Asthma Allergy Clin Immunol, 19, pp.173~180 (1999)
- Kikuchi Y, "Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma", N Engl J Med, 330, pp.1329~1334 (1994)
- Jang AS, "Increased perception of dyspnea by inhalation of short acting β2 agonist in patients with asthma of varying severity", Ann Allergy Asthma Immunol, 84, pp.79~83 (2000)
- Molfino NA, "The fatality- prone asthmatic patient. Follow-up study after near-fatal attacks", Chest, 101, pp.621~623 (1992)
- Sim MK, "Clinical outcomes after recovery from severe exacerbation in asthma", Chonnnm Med J, 38, pp.44~49 (2002)
- National Heart, Lung, "National Asthma Education Program. Expert Panel Report. in: Guidelines for the diagnosis and management of asthma", J Allergy Clin Immunol, 88, pp.425~534 (1991)
- Choi IS, "Risk factors of near-fatal asthma", Korean J Med, 57, pp.52~59 (1999)
- Crapo RO, "Reference spirometric values using techniques and equipment that meet ATS recommendations", Am Rev Respir Dis, 123, pp.659~664 (1981)
- "British guideline on the management of asthma. A national clinical guideline"[URL]
- 문장식, "응급실 내원 천식발작 환자수와 발작 중증도의 최근 변화 추세 -단일기관연구", 천식 및 알레르기, 25(4), pp.284~290 (2005), 대한천식알레르기학회
- Donahue JG, "Inhaled steroids and the risk of hospitalization for asthma", JAMA, 277, pp.887~891 (1997)
- Jonasson G, "Trends in hospital admissions for childhood asthma in Oslo", Allergy, 55, pp.232~239 (2000)
- Ernst P, "Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use", JAMA, 268, pp.3462~3464 (1992)
- Suissa S, "Low-dose inhaled corticosteroids and the prevention of death from asthma", N Engl J Med, 343, pp.332~336 (2000)
- Suissa S, "Inhaled corticosteroids: impact on asthma morbidity and mortality", J Allergy Clin Immunol, 107, pp.937~944 (2001)
- Sin DD, "Inhaled corticosteroid therapy reduces the risk of rehospitalization and all-cause mortality in elderly asthmatics", Eur Respir J, 17, pp.380~385 (2001)
- Taylor DM, "Current outpatient management of asthma shows poor compliance with International Consensus Guidelines", Chest, 116, pp.1638~1645 (1999)
- George MR, "A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma", Arch Intern Med, 159, pp.1710~1716 (1999)
- Najada A, "Outcome of asthma in children and adolescents at a specialty-based care program", Ann Allergy Asthma Immunol, 87, pp.335~343 (2001)
- National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Full report 2007, "National Heart, Lung", ~, pp.NIH publication No. 97-4051 (2007)