Asthma: near-fatal attacks: psychiatric symptoms and denial were common.

Clinical bottom line (level 4)

  1. Psychiatric symptoms appeared common in patients with near-fatal asthma attacks. Many patients were in denial of their symptoms.
Campbell et al: Thorax 1995; 50: 254-259
Expires November 2002

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: 5 acute hospital, Australia

77 patients (aged mean 38 years, 58% male) near-fatal asthma (defined as respiratory arrest, or pCO2 > 50 mmHg)

Excluded if
  • <15





    • Outcomes studied:
  • GHQ 5 or more
  • IBQ 3 or more

    • All patients had structured questionnaires within 10-12 weeks of discharge from hospital, including the General Health Questionnaire: 5 or more indicating psychiatric caseness denial scale from Illness Behaviour Questionnaire: 3 or more indicating significant denial of disease

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    GHQ 5 or more ? 33/77 43%
    (32% to 54%)
    IBQ 3 or more ? 44/77 57%
    (46% to 68%)

    Comments

    1. The psychiatric morbidity was measured after the near-fatal event and could have been generated (in part) by the experience of the event, rather being its cause.
    2. Uncertain how this compares with patients with asthma who do not have near-fatal attacks nor patients with near-fatal episodes of other conditions.

    Citation

    1. Campbell DA, Yellowlees PM, McLennan G, et al: psychiatric and medical features of near fatal asthma. Thorax 1995; 50: 254-259
    Search Terms: reference from review article
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer: Chris van Weel

    Clinical Question.
    Patient near-fatal asthma
    Intervention or Exposure prevalence
    Outcome opinions about symptoms, psychiatric symptoms