ASTHMA

Improved outcomes from acute severe asthma in Australian intensive care units (1996–2003)

Peter J Stow^1,4, David Pilcher^2,4, John Wilson³, Carol George⁴, Michael Bailey⁵, Tracey Higlett⁶, Rinaldo Bellomo^4,7, Graeme K Hart^4,7 and the Australian & New Zealand Intensive Care Society Adult Patient Database Management Committee

¹ Department of Intensive Care, Geelong Hospital, Geelong, Australia
² Department of Intensive Care, Alfred Hospital, Melbourne, Australia
³ Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
⁴ Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database, Melbourne, Australia
⁵ Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
⁶ ANZICS Research Centre for Critical Care Resources, Melbourne, Australia
⁷ Department of Intensive Care, Austin Hospital, Melbourne, Australia

Correspondence to:
Dr David Pilcher
Intensive Care Unit, Alfred Hospital, Commercial Road, Prahran 3181, Victoria, Australia;d.pilcher{at}alfred.org.au

Background: There is limited information on changes in the epidemiology and outcome of patients with asthma admitted to intensive care units (ICUs) in the last decade. A database sampling intensive care activity in hospitals throughout Australia offers the opportunity to examine these changes.

Methods: The Australian and New Zealand Intensive Care Society Adult Patient Database was examined for all patients with asthma admitted to ICUs from 1996 to 2003. Demographic, physiological and outcome information was obtained and analysed from 22 hospitals which had submitted data continuously over this period.

Results: ICU admissions with the primary diagnosis of asthma represented 1899 (1.5%) of 126 906 admissions during the 8-year period. 36.1% received mechanical ventilation during the first 24 h. The overall incidence of admission to ICU fell from 1.9% in 1996 to 1.1% in 2003 (p<0.001). Overall hospital mortality was 3.2%. There was a significant decline in mortality from a peak of 4.7% in 1997 to 1.1% in 2003 (p = 0.014). This was despite increasing severity of illness (as evidenced by an increasing predicted risk of death derived from the APACHE II score) over the 8-year period (p = 0.002).

Conclusions: There has been a significant decline in the incidence of asthma requiring ICU admission between 1996 and 2003 among units sampled by the Australian and New Zealand Intensive Care Society Adult Patient Database. The mortality of these patients has also decreased over time and is lower than reported in other studies.

Abbreviations: ANZICS, Australian and New Zealand Intensive Care Society; APD, Adult Patient Database; COPD, chronic obstructive pulmonary disease; FiO₂, fraction of inspired oxygen; ICU, intensive care unit; PaO₂, PaCO₂, arterial oxygen and carbon dioxide tensions

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