Reduced sensitivity to dyspnea may predispose to severe asthma attacks

NEW YORK (Reuters Health) – Asthmatics with a low perception of dyspnea are more likely to experience near-fatal and fatal asthma attacks than patients with normal or high sensitivity to dyspnea, according to a report published in the February issue of Chest.

Previous study findings have suggested a link between near-fatal asthma attacks and a blunted perception of dyspnea. In the current study, Dr. Paltiel Weiner and colleagues, from Hillel-Yaffe Medical Center in Hadera, Israel, determined the perception of dyspnea (POD) scores of 113 asthmatic patients and assessed their asthma-related outcomes for up to 24 months.

Sixty-seven patients had POD scores that were within normal limits, the authors report. Seventeen patients had scores that were above these limits, and 29 had scores below the normal range.

Patients in the low-POD group tended to be older, more often female, and had disease of longer duration than patients in the other groups, the researchers found. In terms of asthma severity, the low- and high-POD groups were comparable, but the normal-POD group had less severe disease than the other groups.

Despite having a lower mean peak expiratory flow rate, the low-POD group averaged less daily beta-2-agonist use than the high-POD group, the investigators point out (p < 0.01). Significantly more emergency room visits, hospitalizations, near-fatal asthma attacks, and deaths occurred in the low-POD group compared with the other groups.

"To prevent death from asthma, it is important to identify patients who may be at risk of a fatal attack," the authors emphasize. The current findings indicate that measurement of a patient's POD could be useful in this regard. Dr. Weiner's team recommends that all asthma patients should have their POD determined at least once.

In a related editorial, Dr. Thomas K. Aldrich, from Montefiore Medical Center in New York, comments that while POD evaluation may be useful, "home peak flow monitoring and its correlation with symptom diaries would accomplish the same purpose more efficiently, inexpensively, and safely."

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