Résumé
A 56-year-old man was intubated in a commercial centre because of a life-threatening asthma attack. He used to keep his door open every night for 20 years in the eventuality he couldn't breathe or speak for facilitating emergency services access. Subsequent intensive care unit management required a multidisciplinary approach and evidenced gaps in the current understanding of asthma.
Specific mechanisms associated with fatal and near-fatal asthma episodes are reviewed pinpointing current understandings and unmet needs. Smooth-muscle hyperresponsiveness, inflammatory pathways, and mucus plugging are among the key differentiators with non-threatening episodes.
Asthma can also be life-threatening outside these dreadful episodes especially when relying on oral corticosteroids and/or when associated with comorbid conditions.
The conceptual framework evolving from "mild or severe asthma" to "asthma at risk" is discussed, raising the need for identification of strong predictors accessible to interventions.