Malignant potentially fatal asthma: Achievement of remission and the application of an asthma severity index

Patients fulfilling diagnostic criteria for malignant potentially fatal asthma require aggressive involvement by the physician to prevent avoidable fatalities from asthma. Efforts to overcome barriers to treatment caused by noncompliance are critical to successful care. This report reviews five patients with malignant potentially fatal asthma in remission, in whom noncompliance played the major role in preventing control of asthma. Through patient confrontation and the monitoring of serum concentrations of prednisone and its metabolite prednisolone, noncompliance may be addressed. Psychiatric referral may also be of benefit, if accepted by the patient and family. Use of injectable methylprednisolone may be a necessary alternative to prevent life-threatening complications of asthma. In all patients, keeping medical regimens as simple as possible is advocated, with the use of the lowest doses of medication necessary to maintain the control of symptoms, and the prevention of morbidity and mortality. An asthma severity index for the illustration of longitudinal disease severity is applied to these patients.