December 06, 2015

A 23 year old female asthmatic with breathlessness and wheezing


A 23 year old female banker presents to the Emergency Department with shortness of breath. She is wheezing, can barely speak and prefers to sit leaning forwards. She is a known asthmatic who has been using her prescribed steroid inhaler regularly. Few days earlier, she had visited her general practitioner for a cough, for which she was prescribed Erythromycin tablets, but the cough had persisted and deteriorated into her present clinical state.

Which of the following causes of respiratory failure is recognized to have the highest mortality rate?

Please choose one:
a). Chronic obstructive pulmonary disease (COPD)
b). Asthma
c). Acute respiratory distress syndrome (ARDS)
d). Obesity
e). Neuromuscular disease

The correct answer is C

The mortality associated with respiratory failure varies according to the etiology. For ARDS, mortality is approximately 40%-45%; this figure has not changed significantly over the years. Younger patients (<60 years) have better survival rates than older patients. Approximately two thirds of patients who survive an episode of ARDS manifest some impairment of pulmonary function 1 or more years after recovery.

Significant mortality also occurs in patients admitted with hypercapnic respiratory failure. This is because these patients have a chronic respiratory disorder and other comorbidities such as cardiopulmonary, renal, hepatic, or neurologic disease. These patients also may have poor nutritional status.

For patients with COPD and acute respiratory failure, the overall mortality has declined from approximately 26% to 10%. Acute exacerbation of COPD carries a mortality of approximately 30%. The mortality rates for other causative disease processes have not been well described.

A study by Noveanu et al suggests a strong association between the preadmission use of beta-blockers and in-hospital and 1-year mortality among patients with acute respiratory failure.[1] Although cessation exacerbates the mortality, predischarge initiation of beta-blockers is also associated with an improved 1-year mortality.

1). Noveanu M, Breidthardt T, Reichlin T, Gayat E, Potocki M, Pargger H, et al. Effect of oral beta-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study. Crit Care. 2010 Nov 3. 14(6):R198. [Medline]. [Full Text].

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