Near-fatal asthma: recognition and management

Curr Opin Pulm Med. 2008 Jan;14(1):13-23. doi: 10.1097/MCP.0b013e3282f1982d.


Purpose of review: Near-fatal asthma continues to be a significant problem despite the decline in overall asthma mortality. The purpose of this review is to discuss recent advances in our understanding of the pathophysiology, diagnosis and treatment of near-fatal asthma.

Recent findings: Two distinctive phenotypes of near-fatal asthma have been identified: one with eosinophilic inflammation associated with a gradual onset and a slow response to therapy and a second phenotype with neutrophilic inflammation that has a rapid onset and rapid response to therapy. Patients who develop sudden-onset near-fatal asthma seem to have massive allergen exposure and emotional distress. In stable condition, near-fatal asthma frequently cannot be distinguished from mild asthma. Diminished perception of dyspnea plays a relevant role in treatment delay, near-fatal events, and death in patients with severe asthma. Reduced compliance with anti-inflammatory therapy and ingestion of medications or drugs (heroin, cocaine) have been associated with fatal or near-fatal asthma.

Summary: Near-fatal asthma is a subtype of asthma with unique risk factors and variable presentation that requires early recognition and aggressive intervention.

Publication types

  • Review

MeSH terms

  • Anti-Asthmatic Agents / therapeutic use
  • Hospitalization
  • Humans
  • Monitoring, Physiologic / methods
  • Phenotype
  • Prognosis
  • Respiration, Artificial
  • Respiratory Function Tests
  • Respiratory Insufficiency / etiology*
  • Respiratory Insufficiency / therapy
  • Risk Factors
  • Status Asthmaticus / complications
  • Status Asthmaticus / diagnosis*
  • Status Asthmaticus / physiopathology
  • Status Asthmaticus / therapy


  • Anti-Asthmatic Agents