Respiratory failure from asthma. A marker for children with high morbidity and mortality
R. W. Newcomb and J. Akhter
Department of Pediatrics, University of Chicago Pritzker School of Medicine.
During a seven-year interval, 78 children had documented episodes of
respiratory failure from asthma, defined as arterial hypoxemia,
hypercapnia, or use of mechanical ventilatory support or intravenous
isoproterenol hydrochloride. During 407 patient-years of follow-up (5.2
years per patient), these 78 children had 227 episodes of respiratory
failure (2.9 episodes per patient). Fifty-three patients (68%) have had two
or more of such episodes. Second episodes usually followed the initial
episodes within two years, but some were delayed for over six years. Seven
of the 78 children died, and two others have incurred hypoxic brain damage,
compared with two deaths among 2892 children with asthma--seen at this
hospital during that interval--but without a documented previous episode of
respiratory failure. We conclude that children whose asthma has caused even
one episode of respiratory failure constitute a special group of asthmatic
patients, members of which are at high risk for repeated episodes of
respiratory failure and its catastrophic complications. This recognition
allows special attention to be focused on them in designing both clinical
and research strategies.
