Severity differences may in part explain the large varia tions in asthma mortality that occur in different coun tries. This study examines the use of APACHE II for measuring asthma severity in 118 adult asthma admis sions at one intensive care unit in New Zealand during 1987-1988. Most admissions were hypercapnic (72%), and 61 % had an altered level of consciousness. Mean APACHE II score was 20 in the emergency department and 12 upon ICU admission. We summarize the extent of physiological derangement using four acute physiol ogy score (APS) ranges. Each APS range stratified admis sions into groups with differing clinical course, therapy, and outcome. These results document a high level of asthma severity among patients treated in New Zealand, the country with the world's highest asthma mortality. APACHE II provides a valid and reproducible measure of asthma severity and should be useful for describing and comparing international differences in asthma severity and as a case-mix control in studies of asthma therapy.
Get full access to this article
View all access options for this article.
References
1.
Sheehy AF, DiBenedetto R., Lefrak S., et al. Treatment of status asthmaticus. Arch Intern Med1972;130:37-42
2.
Mountain RD, Sahn SAClinical features and outcome in patients with acute asthma presenting with hypercapnia. Am Rev Respir Dis1988;138:535-539
3.
Knaus WA, Draper EA, Wagner DP, Zimmerman JEEvaluation of outcome from intensive care in major medical centers. Ann Intern Med1986;104:410-418
4.
Mitchell EADemographic characteristics of asthma admissions to hospitals. NZ Med J1986;99:576-579
5.
Zimmerman JE , Knaus WA, Judson JA, et al. Patient selection for intensive care: a comparison of New Zealand and United States hospitals. Crit Care Med1988;16:318-326
6.
Benatar SRFatal asthma. N Engl J Med1986;314:423-429
7.
Woolcock AJWorldwide differences in asthma prevalence and mortality. Chest1986;90:40S-45S
8.
Sears MR, Beaglehole R.Asthma morbidity and mortality: New Zealand. J Allergy Clin Immunol1987;80:383-388
9.
Jackson R., Sears MR, Beaglehole R., Rea HHInternational trends in asthma mortality: 1970 to 1985. Chest1988;94:914-918
10.
Sears MR, Rea HH, de Boer G., et al. Accuracy of certification of death due to asthma: a national study. Am J Epidemiol1986;24:1004-1011
11.
Sly RMIncreases in deaths from asthma. Ann Allergy1984; 53:20-25
12.
Grant Iwb.Asthma in New Zealand. Br Med J1983;286:374-377
13.
Wilson JD, Sutherland DC, Thomas ACHas the change to beta-agonists combined with oral theophylline compounds increased cases of fatal asthma?Lancet1981 ;1:1235-1237
Rea HH, Sears MR, Beaglehole R., et al. Lessons from the national asthma mortality study: circumstances surrounding death. NZ Med J1987;100:10-13
16.
Beaglehole R., Jackson R., Sears MR, Rea HHAsthma mortality in New Zealand: a review with some policy implications. NZ Med J1987 ;100:231-234
17.
Stableforth D.Death from asthma. Thorax1983;38:801—805
18.
Sears MR, Rea HH, Rothwell Rpg, et al. Asthma mortality: comparison between New Zealand and England . Br Med J1986;293:1342-1345
19.
Waite DA, Eyles EF, Tonkin SL, O'Donnell TV. Asthma prevalence in Tokelauan children in two environments . Clin Allergy1980;10:71-75
20.
Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system for acutely ill patients. Crit Care Med1985;13:818-829
21.
Sears MR, Rea HH, Beaglehole R., et al. Asthma mortality in New Zealand: a two year national study. NZ Med J1985; 98:271-275
22.
American Thoracic Society.Standards for the diagnosis and treatment of COPD and asthma. Official statement of the American Thoracic Society. Am Rev Respir Dis1987;136: 225-244
23.
Rea HH, Scragg R., Jackson R., et al. A case-control study of deaths from asthma. Thorax1986;41:833-839
24.
Sears MR, Rea HHPatients at risk for dying of asthma: New Zealand experience. J Allergy Clin Immunol1987;80:477-481
25.
Rebuck AS, Read J.Assessment and management of severe asthma. Am J Med1971;51:788-798
26.
Rebuck AS, Braude AC, Chapman KREvaluation of the severity of the acute asthmatic attack. Chest1982;82:285-295
27.
Fischl MA, Pitchemk A., Gardner LBAn index for predicting relapses and need for hospitalization in patients with acute bronchial asthma. N Engl J Med1981;305:783-789
28.
Nowak RM, Tomlanovich MC, Sarkar DD, et al. Arterial blood gases and pulmonary function testing in acute bronchial asthma: predicting patient outcome. JAMA1983;249: 2043-2046
29.
Edelson JD, Rebuck ASThe clinical assessment of severe asthma. Arch Intern Med1985;145:321-323
30.
Darioli R., Perret C.Mechanical controlled hypo-ventilation in status asthmaticus. Am Rev Respir Dis1984;129:385-387
31.
Larvin M., McMahon MJAPACHE II score for assessment and monitoring of acute pancreatitis. Lancet1989;2:201-204
32.
Chang Rws, Jacobs S., Lee B.Use of APACHE II severity of disease classification to identify intensive care unit patients who would not benefit from total parenteral nutrition. Lancet1986;1:1483-1487
33.
Sutherland DC, Beaglehole R., Fenwick J., et al. Death from asthma in Auckland: circumstances and validation of causes. NZ Med J1984;97:845-848
34.
Johnson AJ, Nunn AJ, Sommer AR, et al. Circumstances of death from asthma. Br Med J1984;288:1870-1872
35.
Barriot P., Riou B.Prevention of fatal asthma. Chest1987; 92:460-466
36.
Thornley PE , Dawson KPAsthma in New Zealand. Br Med J1983;286:890
37.
Mahood CBAsthma in New Zealand. Br Med J1983;286:891
38.
Wagner DP, Knaus WA, Draper EAPhysiologic abnormalities and outcome from acute disease. Arch Intern Med1986;146:1389-1396
39.
Wagner DP, Knaus WA, Draper EAStatistical validation of a severity of illness measure. Am J Public Health1983;23:878— 884
40.
Knaus WA, Le Gall JR, Wagner OP, et al. A comparison of intensive care in the USA and France. Lancet1982;2:642-646
41.
Bion JF, Edlin SA, Ramsey G., et al. Validation of a prognostic score in critically ill patients undergoing transport. Br Med J1985;291:432-434
42.
Knaus WA, Wagner DR, Draper EAThe value of measuring severity of disease in clinical research on acutely ill patients. J Chronic Dis1984;37:455-463
43.
Jennett B., Teasdale G.Management of head injuries. Philadelphia: Davis, 1982:317-332
FitzGerald JM, Hargreave FEThe assessment and management of acute life threatening asthma. Chest1989;95:888-894
47.
Jederlinic PJ, Irwin RSStatus asthmaticus. J Intensive Care Med1989;4:166-184
48.
Williams S. , Seaton A.Intravenous or inhaled salbutamol in severe acute asthma?Thorax1977;32:555-558
49.
Williams SJ , Winner SJ, Clark Tjh.Comparison of inhaled and intravenous terbutaline in acute severe asthma. Thorax1981;36:629-631
50.
Cheong B., Reynolds SR, Rajan G., Ward MJIntravenous β agonist in acute severe asthma. Br Med J1988;297:448-450
51.
Mitchoefer JC, Runster RH, Karetzky MSThe use of sodium bicarbonate in the treatment of acute bronchial asthma. N Engl J Med1965 ;272:1200-1203
52.
Lakshminarayan S., Sahn SA, Petty TLBicarbonate therapy in severe acute respiratory acidosis. Scand J Respir Dis1973; 54:128—131
53.
Zwillich CW , Pierson DJ, Lakshminarayan S., Weil JVEffect of sodium bicarbonate infusion in acute respiratory acidosis and acute metabolic acidosis . Circ Shock1976;3:39-43
54.
Montgomery AB, Stager MA, Carrico CJ, Hudson LDCauses of mortality in patients with the acute respiratory distress syndrome. Am Rev Respir Dis1985;132:485-489
55.
Dellinger EP , Wertz MJ, Meakins JL, et al. Surgical infection stratification system for intra-abdominal infection. Arch Surg1985;120:21-29
56.
Durocher A. , Saulnier F., Beuscart A., et al. A comparison of three severity score indexes in an evaluation of serious bacterial pneumonia. Intensive Care Med1988;14:39-43
57.
Rose CC, Murphy JG, Schwartz JSPerformance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department treatment. N Engl J Med1984;310:573-577
58.
Centor RM, Yarbrough B., Wood JPInability to predict relapse in acute asthma. N Engl J Med1984;310:577-580
59.
Kelsen SG, Kelsen DP, Fleegler BF, et al. Emergency room assessment and treatment of patients with acute asthma. Am J Med1978;64:622-628
