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(2008). Asthma. Retrieved on May 1, 2014 from

http://www.lung.org/lung-disease/asthma/resources/facts-and-

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D=2154921&PDFSource=13

Asthma has a severe impact on impoverished urban populations, such as Chicago, and constitute a significant public health problem . According to a study, the 1996 asthma hospitalization rate for Chicago was 42.8 per 10,000, representing twice the

amount as suburban Chicago and US rates^5. Furthermore, it was found that Medicaid patients were overrepresented in the study and the length of stay was longer for the elderly and Medicaid patients^5. The study showed that while the age-adjusted asthma

mortality in Chicago was 4.7 times greater in Non-Hispanic Blacks compared to Non-Hispanic Whites, the asthma mortality for Hispanics doubled in the past decade^ 5. Nationally, the black/white asthma mortality ratio 2.5 :1^5

ASthma places a significant economic burden on society. The disease accounts for 12.8 million annual school days missed from childhood asthma and 10.1 million annual work days from adult asthma^2. In terms of its cost to our health system, asthma results

in annual direct costs of $50.1 billion (including prescription medications, hospital care, and physician services) and indirect costs of $5.9 billion (including lost productivity and premature mortality)^4 Our study will focus on identifying the risk factors present in

those with acute respiratory failure in order to identify and address those at highest risk. Intensive therapy with inhaled bronchodilators and systemic corticosteroids is usually sufficient to reduce airflow obstruction and ameliorate symptoms in patients with

acute asthma. However, some patients develop respiratory failure and require supportive care with mechanical ventilation (approximately 4 percent of all patients hospitalized for acute asthma) [1]. Although life-saving, mechanical ventilation and its associated

interventions (eg, sedatives, paralytics) can also cause morbidity and mortality

Asthma is a serious health risk in the US. Every day in this country,

there are approximately

63,000 individuals who will miss school or work due to asthma,

34,000 will suffer an asthma attack,

over 5000 will seek care in the ED,

1,300 will be hospitalized, and

10 will die from asthma ^2.

It was estimated in 2011 that 25.9 million Americans currently have

asthma (including 7.1 million children), of which 13.2 million people

had an asthma attack^3. In 2009, there were 3,388 asthma-linked

deaths – further represented by an age-adjusted rate of 1 .1 per

100,000- of which 63% of deaths occured with Females.

Asthma is a reversible obstructive pulmonary disease, triggered by an

increased airway response to certain stimuli. In the acute phase,

symptoms of asthma usually arise from bronchospasm, which is

influenced by airway caliber, airflow and the underlying bronchial

hyperresponsiveness. The airflow limitation in asthma is recurrent and

caused by changes in the airway, including bronchoconstriction, airway

edema, airway hyperresponsiveness, and airway remodeling. Acute

respiratory failure is brought on by unrelenting bronchospasm, airway

inflammation, airway edema, and mucus plugging which dramatically

increase airflow obstruction, decrease expiratory flow, and prolong the

time needed to complete exhalation prior to the onset of the next breath.

When the expiratory time is insufficient to completely exhale, inadequate

emptying between breaths causes progressive hyperinflation. This is

called dynamic hyperinflation, a common problem in patients with status

asthmaticus.Dynamic hyperinflation creates intrinsic PEEP and elevates

the plateau pressure (Pplat), which can lead to cardiovascular collapse

and barotrauma, as well as increase the work of breathing. Respiartory

failure is managed with mechanical venitilation and subsequent ICU

admission increase overall morbidity and mortality and steps must be

taken to identify the highest risk patients so that a focused effort can be

made to establish effective asthma action plans and address risk factors.

Factors predictive of acute respiratory failure in asthma patients in an urban under

served setting

Epidemiology Results

Abstract

Study Limitation

References

Acknowledgements

Avoidance of triggers and awareness of asthma

action plan is paramount to prevention of sever

acute exacerbations. Early identification of a

severe asthma attack is vital for timely

intervention. Medical follow-up is essential key to

long-term survival. Survivors of near death due to

asthma often demonstrate a lot of denial

regarding their illness, and anxiety/depression

appears to be more common . Medical

noncompliance , tobacco/drug use and

psychological dysfunction are commonplace

among our population. The challenge is to

demonstrate to such patients that they can

manage their illness. This requires a coordinated

team approach involving the inpatient and

outpatient medicine and nursing services, and the

use of community resources like asthma support

groups. Intervention points must be identified so

that both preventive and therapuetic measure

may be taken.

Objective:

Understanding factors predictive of acute respiratory failure secondary to

asthma in underserved urban populations.

Study Site:

JPH ICU/Step down (8 beds) & ER, an urban community teaching hospital

in under-served area

Study population:

Adult patients with a Diagnosis of acute respiratory failure secondary to

asthma presenting at JPH ER/ICU between Jan 2012 and Jan 2014

Methodology:

Retrospective Chart Review of Patients with a diagnosis of acute

respiratory failure secondary to asthma. Patients who had documented

asthma action plan, adherence to plan (Full Partial or Non Compliant),

and developed acute respiratory failure. We will evaluate documentation

of diagnostic criteria for respiratory failure, LOS, morbidity and mortality

rates in our community. Evaluate trigger factors in our population,

including a history of previous exacerbations, poor asthma control, poor

inhaler technique, a history of prior respiratory tract infection, poor

adherence to medication, presence of allergic rhinitis, gastro-esophageal

reflux disease, psychological dysfunction, smoking, and obesity.

Exclusion Criteria

Respiratory failure from causes other than asthma

Inclusion Criteria

Have a confirmed or suspected acute respiratory failure secondary to

asthma, previous established diagnosis of asthma especially patients who

have moderate or severe persistent asthma, a history of severe

exacerbations, or poorly controlled asthma

Conclusion/Reccomendations Pathophysiology

Diagnosis

•Diagnosis of respiratory failure in asthmatics is based on clinical

signs and symptoms and confirmed by laboratory evidence of

respiratory failure

•Mental Status

•Breath Sounds-wheezing, absence of breath sounds

•Work of breathing

•Oxygen Saturation less than 88%

•Arterial Blood gases demonstrating hypercapnia/hypoxia

•Peak Flow

Our Study: Retrospective

Number of asthma

exacerbation admitted at

Jackson Park Hospital: Year 2011 885

Year 2012 864

Year 2013 773

Number of patients who had

acute respiratory failure

secondary to status

asthmaticus 57

MEDIAN AGE: 54.7 years

GENDER: (63%) Female

DRUG USE: (50%) screened positive

for illicit drugs with a larger portion of

patients + Heroin vs. Cocaine

SMOKING STATUS: (61%) tobacco.

URI: (27%) reported URI preceding

symptoms.

MENTAL HEALTH: (28%)had

psychological dysfunction.

Prior Hx of Respiratory Failure 44% PRE-INTUBATION SYMPTOMS:

2.78 days

Diagnostic Cirteria

Mental Status- 39%

Breath sounds- 28%

Work of breathing- 34%

O2 Sat- 96%

Pre-Intubation ABG- 57%

Peak Flow- 11%

NEBULIZER TX: 4.63 average

MgSo4: 54%

Heliox: 13%

NIPPV: 50%

Length of stay (10.3 days)

Mortality rate- 7.2%

Sample size

Adult Population

Documentation

Data Collection