HEALTH-CARE UTILIZATION AFTER NEAR-FATAL ASTHMA

Near-fatal asthma has been repeatedly associated with an increased risk of premature death. Despite a higher risk, death after near-fatal asthma remains infrequent. Few studies have examined the long-term outcome of those who experience a near-fatal event but do not succumb to asthma. We therefore contacted patients who had an episode of near-fatal asthma 5 to 10 years earlier and documented their use of health-care services for asthma. Each index case was compared with two age-matched controls who had been hospitalized for severe but not near-fatal asthma within 2 years of the index case admission. Thirty-seven index cases and 74 control subjects were assessed. Demographics did not distinguish the two groups. Availability of primary care physicians and asthma specialists were similar. There was no difference in the frequency of hospitalizations, emergency room visits, or visits to physicians for asthma between the two groups. ICU admissions were extremely infrequent. Although the mean number of ICU admissions per subject were similar in the year preceding our contact (0.03+/-0.16 in each group), there was a trend toward ICU admissions occurring more often in the near-fatal group (0.62+/-1.67 vs 0.31+/-0.91 admissions/subject). Days away from work were more frequent in the control group (3.5+/-5.5 vs 1.6+/-3.3 d/yr) including days away from work in the year preceding our contact (8.9+/-43 vs 1.8+/-6.1 d). The data suggests that with regards to characteristics and health-care utilization, it may not be possible to distinguish people with near-fatal asthma from those who are hospitalized without a near-fatal event.