Life-threatening asthma.

I review my experience with life-threatening asthma, defined as hypercapnia, need for intubation, or death, at a large municipal hospital during a ten-year period. Such severe illness is rare among asthmatics and predicting its occurrence is difficult. Eighty patients had 111 admissions for life-threatening asthma; 773 patients were hospitalized for asthma 851 times during the study period. Only 15% of these 773 patients had experienced severe asthma previously and the duration of asthma and frequency of hospitalization was similar to that of the other patients admitted for asthma. Follow-up study of the survivors of life-threatening asthma has revealed a very high rate of recurrence. More than 35% had a recurrence in one to ten years, and those who had three to four episodes had a recurrence rate of 45% and 60%, respectively. Although life-threatening asthma is rare, unpredictable, and occurs only after many years of symptomatic illness, once it does occur there is a real risk of recurrence. Patients who have experienced such a severe episode of asthma require continuing careful supervision and management.