Characteristics of Patients with Asthma Attack Followed in the Intensive Care Unit

Year 2023, , 622 - 637, 29.10.2023

Selen Karaoğlanoğlu , Özge Bostan , Serpil Öcal , Ebru Ersoy Ortaç , Ahmet Demir , Gül Karakaya , Ali Fuat Kalyoncu

https://doi.org/10.19127/mbsjohs.1289201

Abstract

Objective: Asthma attack is a critical reason for morbidity and mortality if not treated effectively at the right time. Data about the efficiency of noninvasive and invasive mechanical ventilation (NIV, IMV) in respiratory failure due to asthma attacks are scant. The aim of this study was to investigate the relationship between asthma-related factors, medical and NIV/IMV treatments received in the Intensive Care Unit (ICU), and the mortality rates and length of hospital stay, in asthma attacks.
Methods: The characteristics of patients with severe asthma treated in Hacettepe University Medical ICU for a ten-year period were analyzed from patient records retrospectively. The association between age, sex, comorbidities, asthma duration, treatment, adherence to the treatment, the effectiveness of NIV/IMV treatment if performed, and asthma attack severity, length of hospital stay, and mortality were investigated.
Results: A total of 22 patients were included in this study. In addition to medical treatment, eight (36.6%) patients received NIV, five (22.7%) received invasive mechanical ventilation (IMV), and five (22.7%) patients had both. Four (18.1%) patients died in the ICU. There was no significant relationship between these parameters and length of hospital stay and mortality. The relationship between baseline PaCO2, pH, and HCO3 and the difference of PaCO2, pH, and HCO3¯ changes were significant, indicating the correct and effective use of NIV/IMV.
Conclusion: NIV applications, which have been proven to be effective in hypercapnic respiratory failure, were also found to be effective in hypoxemic respiratory failure due to asthma attacks. The absence of a relationship between the investigated parameters and mortality revealed that the reasons for the mortality might be infections or comorbidities, not the respiratory tract.

Keywords

Asthma, severe asthma, asthma attack, intensive care unit

Project Number

yok

References

• Cevhertas L, Ogulur I, Maurer DJ, Burla D, Ding M, Jansen K, et al. Advances and recent developments in asthma in 2020. Allergy 2020;75(12):3124-3146.
• Busse WW, Fang J, Marvel J, Tian H, Altman P, Cao H. Uncontrolled asthma across GINA treatment steps 2 - 5 in a large US patient cohort. J Asthma 2022;59(5):1051-1062.
• Çelik G, Aydın Ö, Türk Toraks Derneği Astım ve Alerji Çalışma Grubu. Astım Tanı ve Tedavi Rehberi, Astımın Kronik Tedavisi Basamak Tedavisi 2022 Güncellemesi
• Kostakou E, Kaniaris E, Filiou E, Vasileiadis I, Katsaounou P, Tzortzaki E, et al. Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management. J Clin Med 2019;8(9):1283.
• Agnihotri NT, Saltoun C. Acute severe asthma (status asthmaticus). Allergy Asthma Proc 2019;40(6):406-409.
• Pallin M, Hew M, Naughton MT. Is non-invasive ventilation safe in acute severe asthma? Respirology 2015;20(2):251-7.
• Pallin M, Naughton MT. Noninvasive ventilation in acute asthma. J Crit Care 2014;29(4):586-93.
• Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax 2016;71 Suppl 2:ii1-35.
• Sheikh M, Tiruvoipati R, Hurley JC. Non-invasive ventilation of patients with acute asthma. Intern Med J 2019;49(2):262-264.
• Binachon A, Grateau A, Allou N, Ferdynus C, Allyn J, Dangers L, et al. Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study. PLoS One 2020;15(10):e0240063.
• Althoff MD, Holguin F, Yang F, Grunwald GK, Moss M, Vandivier RW, et al. Noninvasive Ventilation Use in Critically Ill Patients with Acute Asthma Exacerbations. Am J Respir Crit Care Med 2020;202(11):1520-1530.
• Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022 (GINA, 2022).
• El Shinnawy OM, Metwally M, Abdel Aleem NA, Eid WM. Assessment of noninvasive ventilation in patients with acute severe asthma. Egypt J Chest Dis Tuberc 2022;71:67-73.
• Shigemura M, Homma T, Sznajder JI. Hypercapnia: An Aggravating Factor in Asthma. J Clin Med 2020;9(10):3207.
• Vasileiadis I, Alevrakis E, Ampelioti S, Vagionas D, Rovina N, Koutsoukou A. Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology. J Clin Med 2019;8(4):563.
• Senna G, Latorre M, Bugiani M, Caminati M, Heffler E, Morrone D, et al. Sex Differences in Severe Asthma: Results From Severe Asthma Network in Italy-SANI. Allergy Asthma Immunol Res 2021;13(2):219-228.
• Chowdhury NU, Guntur VP, Newcomb DC, Wechsler ME. Sex and gender in asthma. Eur Respir Rev 2021;30(162):210067.
• Mikhail I, Grayson MH. Asthma and viral infections: An intricate relationship. Ann Allergy Asthma Immunol 2019;123(4):352-358.
• Martin MJ, Beasley R, Harrison TW. Towards a personalised treatment approach for asthma attacks. Thorax 2020;75(12):1119-1129.