Respiratory – How to recognise patients at-risk of near-fatal asthma

Combination of Severe Asthma

• Previous near-fatal attack: including ventilation or respiratory acidosis
• Previous admission for asthma, especially in the last year
• Requiring 3 classes of asthma medications
• Heavy use of β2-agonist
• Repeated attendance at A&E for asthma care, particularly in the last year
• Brittle asthma

And Adverse Behavioural or Psychosocial Features

• Non-compliance with treatment or monitoring
• Failure to attend appointments
• Self-discharge from hospital
• Psychosis, depression, other psychiatric illness or deliberate self-harm
• Current or recent major tranquilliser use
• Denial
• Alcohol or drug abuse
• Obesity
• Learning difficulties
• Employment problems
• Income problems
• Social isolation
• Childhood abuse
• Severe domestic, marital or legal stress

Medical Management

• Inadequate treatment with inhaled corticosteroids
• Inadequate objective monitoring of asthma
• Underuse of written Self Management Plan
• Non adherence with treatment