A new look at adult asthma.
ABSTRACT Understanding of the natural history of asthma is hampered by the lack of precise definitions. A new definition of severe acute asthma is proposed with primary emphasis on the circulatory disturbances. The natural history of severe acute asthma and the value of steroid therapy are re-examined in the light of the new definition.
- SourceAvailable from: ncbi.nlm.nih.govThorax 09/1992; 47(8):582-3. · 8.38 Impact Factor
Article: Status asthmaticus in adults[Show abstract] [Hide abstract]
ABSTRACT: Status asthmaticus is a severe, life-threatening exacerbation of bronchial asthma that fails to improve with "conventional" treatment. "Conventional" treatment has been defined as three subcutaneous injections of epinephrine given at 15-min intervals. The use of the term "status asthmaticus" has value in that it has simplified communication. However, it has the disadvantages that it is too restrictive. It draws attention away from other aspects of severe asthma; for example, that patients die at home L2 and, in some cases, within minutes of the onset of an attack/'3 It is probably more useful to talk of "severe acute asthma," rather than "status asthmaticus. "4 Between 1959 and 1979, the overall mortality due to asthma in patients from 5 to 34 years of age ranged from 0.2 to 4.1 deaths per 100,000 persons. In the United States and Canada, mortality was fairly constant, being between 0.2 and 0.4 deaths per 100,000 persons, s The hospital mortality for severe acute asthma in adult patients is shown in Table 1. The mean mortality is 1.34%. Asthma remains a potentially lethal disease, and its mortality has not declined significantly over the last 20 years.Clinical Reviews in Allergy & Immunology 3(1):69-94. · 5.59 Impact Factor
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ABSTRACT: The value of corticosteroids in severe acute asthma continues to be debated. Ninety consecutive patients admitted to the emergency room with severe acute asthma were studied in a randomised, double blind, controlled trial to determine the efficacy of corticosteroids. Eighty two patients completed the study. All received oxygen therapy and intensive bronchodilator treatment. The patients were divided into three groups for steroid treatment, receiving intravenous methylprednisolone 10 mg/kg every four hours for 48 hours (29 patients, group A); intravenous methylprednisolone 2 mg/kg every 4 hours for 48 hours (27 patients, group B); or no intravenous corticosteroids (26 patients, group C). There were no differences on admission among the three groups in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), or arterial oxygen or carbon dioxide tension; and the rates of recovery in FEV1, FVC, and PEF were similar. Corticosteroids given with bronchodilators have not shown a beneficial effect in the first 48 hours of recovery of severe acute asthma. Only in those patients who failed to respond by the third hour of treatment, and in those who were previously taking oral corticosteroids, does a favourable, though not statistically significant, effect appear to occur.Thorax 09/1992; 47(8):588-91. · 8.38 Impact Factor