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Rapid-Onset Asthma Attacks Are Different

Acute severe asthma may have a rapid or a slow onset. Patients with rapid-onset attacks are thought to be more likely to die from an acute asthma exacerbation, whereas those with slow-onset attacks are expected to exhibit more gradual clinical and functional deterioration. These authors in Uruguay compared patients with rapid- and slow-onset attacks in a prospective cohort study of 403 adult asthmatics who presented with FEV₁ below 50 percent.

Onset was considered rapid if symptoms developed within 6 hours and slow if symptoms developed over 6 or more hours; 11.3 percent of patients had rapid-onset attacks. Compared with the slow-onset group, patients in the rapid-onset group were significantly more likely to be male, to have no identifiable cause of attacks, and to respond quickly to beta-agonist therapy; these patients were less likely to have antecedent upper respiratory infections or to require hospital admission. The quicker response to therapy and lower rate of admission in the rapid-onset group occurred despite significantly lower pulmonary function at presentation in these patients. There were no data on mortality.

Comment: Rapid-onset asthma attacks are a relatively uncommon presentation. These attacks may be associated with more severe airflow obstruction and quicker response to treatment. The data indicate that the most worrisome asthma patients may be those with acute onset who do not respond quickly.

— CV Pollack

Published in Journal Watch Emergency Medicine February 28, 2001

Citation(s):

Rodrigo GJ and Rodrigo C. Rapid-onset asthma attack: A prospective cohort study about characteristics and response to emergency department treatment. Chest 2000 Dec 118 1547-1552.

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