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.
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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
- Thorax 09/1992; 47(8):582-3. · 8.38 Impact Factor
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ABSTRACT: The most vulnerable population in the recent increase in morbidity and mortality in asthma is the preteen and teenaged group. This particular group, remarkably resistant to outside input, would seem the most likely audience for programs dealing with asthma self-care. We have postulated 4 problem areas for this group that may be important in patients who have severe or refractory disease. These problems involve physiology, noncompliance with the medical regimen, stress, and depression and suicide. Each problem requires a specific intervention strategy and should be amenable to treatment in a comprehensive management plan.Clinical Reviews in Allergy 09/1987; 5(3):273-84.