Fatal and near-fatal asthma

Article Abstract:

Asthma is a relatively common disease, and although its mortality is rising, many physicians and asthma patients still view it as an annoyance rather than as a potentially fatal disease. In the United States approximately 4,800 people died of asthma in 1985, and the tragedy is that most of these deaths were preventable. Failures on the part of the physician in recognizing the severity of the attack and in treating it appropriately, or on the part of the patient in responding quickly enough and communicating clearly with the physician can lead to serious complications and death. Recovery can be rapid even from large amounts of carbon dioxide in the blood (hypercapnia) with proper therapy. When too high a concentration of oxygen is administered, it can worsen carbon dioxide retention or cause its recurrence. Oxygen levels should be reduced to one to two liters per minute. No one knows how these attacks are caused, although stress, pollution, beta blockers used to treat hypertension, and aspirin and other nonsteroidal anti-inflammatory agents are implicated. In an article in the New England Journal of Medicine, February 7, 1991, O'Hollaren and his colleagues suggest that a fungus common especially in the American Midwest can cause asthma attacks. The possible mechanisms causing fatal and near-fatal attacks are summarized, and two groups of patients at high risk are noted. One group of patients is unable to sense even marked airway obstruction, and these people may report breathlessness and wheezing when they may in fact be close to death. The other group does not respond to bronchial narrowing by increased respiration, and even moderate obstruction leads to lack of ventilation. These two types are rare, but must be recognized to avoid preventable deaths. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Risk factors, editorial

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Asthma

Article Abstract:

Asthma is a chronic respiratory illness characterized by periods of coughing, difficulty breathing, wheezing and chest tightness. Patients may wake up at night or early in the morning experiencing these symptoms or may develop them in response to such things as physical activity, cold air and irritants like perfume. Patients' airways appear to be inflamed even when they are asymptomatic, but the inflammation seen in asthma patients is significantly different from that associated with smoking and bronchitis. White blood cell distribution is abnormal, with almost no neutrophils and an abundance of eosinophils. Some studies have found an increase in mast cells as well. Two studies report inhalation treatment with steroids lowers the number of eosinophils and mast cells, but it is not clear if this reduces airway reactivity. Beta2-agonists have been used to treat asthma for years, but recent findings suggest they may adversely affect some patients. Treatment should be determined on an individual basis.

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Effect of long-term salmeterol treatment on exercise-induced asthma

Article Abstract:

Salmeterol may lose its effectiveness in preventing exercise-induced bronchoconstriction in asthma patients when it is taken long-term. Researchers measured lung function 30 minutes after the morning dose of salmeterol and nine hours later in 20 patients who took the drug or a placebo twice a day. Lung function was measured while the patients exercised on a stationary bicycle. Compared to placebo, the drug reduced the degree of bronchoconstriction, but as the 30-day study progressed, the drug became less effective.

Evaluation, Drug therapy, Salmeterol, Exercise, Exercise physiology

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