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.
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 02/1985; 3(1):69-94. DOI:10.1007/BF02993043 · 4.73 Impact Factor
Article: Acute severe asthma.Journal of the Royal Society of Medicine 03/1982; 75(2):138. · 2.02 Impact Factor
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ABSTRACT: Venous whole-blood eosinophil counts were performed on 50 occasions in 42 patients with varying patterns of asthma. None of the patients studied had received systemic corticosteroids during the previous year. Patients with acute severe asthma, as defined by symptomatic airways obstruction with a tachycardia of at least 120 beats/min, showed eosinopenia (21 x 10(9)/l +/- SD 57 x 10(9)/l). Patients with chronic asthma, as defined by symptomatic airways obstruction with a heart rate of less than 100 beats/min, showed appreciable eosinophilia (1048 x 10(9)/l +/- SD 708 x 10(9)/l). Finally, asymptomatic patients had a variable total eosinophil count but with values lower than those of patients with chronic asthma (345 x 10(9)/l +/- SD 431 x 10(9)/l). Eosinophilia may contain chronic asthma, thereby mediating bronchial damage, whereas absence of eosinophils in acute asthma enables vasoactive mediators to enter the systemic circulation, possibly causing circulatory disturbances.British medical journal (Clinical research ed.) 11/1982; 285(6350):1229-31. DOI:10.1136/bmj.285.6350.1229