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Summary of workshop discussion
R. Wchael Sly, M.D., Richard R. Rosenthal, M.D., and Richard A. Nick&, M.D. Washington, D.C., and Baltimore, Md.
There is clearly a pharmacologic basis for asthma mortality, but whether there is a pharmacologic basis for increased asthma mortality is not known. It is not difficult, however, to envision a subtle pharmacologic basis for increases in asthma mortality, related to the way in which drugs are used in the treatment of asthma. Such an effect has been recognized in the United Kingdom when patient and physician management of asthma has been less than optimal.’ There are probably far too many physicians in the United States as well who do not appreciate current concepts on the treatment of asthma, especially as they relate to the use of corticosteroids and cromolyn sodium and the individualization of treatment with theophylline. This may be a manifestation of the tendency to place too much reliance on primary care physicians or others not specialized in the care of patients with asthma. There is also pressure on primary care physicians to accept total responsibility for patient care and to utilize referral systems sparingly. Primary responsibility for patient management is often relegated to nonphysicians as well. Pressure for shorter hospital stays could conceivably be associated with the relatively high risk of acute asthmatic relapse
In order to minimize the risk of murbidity and death induced by asthma, it will be necessary (1) to make sure that patients with asthma and the physicians who treat them are familiar with the optimal management of asthma, (2) to expand research on the pharmacologic.basis of such adverse events, and (3) to improve collection and hand&g of data to clarify the possible pharmacologic basis for increases in asthma-related deaths. 438
and death in the 2-week period after the patient leaves the hospital. ‘. ’ What is the adequacy of pharmacologic treatment for “new” groups in this country, such as the increasing number of Asian patients, or for other groups for whom language barriers may exist? To what degree does distraction of patients from appropriate to inappropriate care and/or inability of patients to afford adequate pharmacologic management contribute to asthma mortality? Certainly, there are many questions that remain to be answered before it will be possible to reach definitive conclusions about the degree to which pharmacologic management of asthma directly or indirectly contributes to asthma mortality.
1. Stableforth DE. Asthma deaths in the United Kingdom. In: International Symposium on Status Asthmaticus and Asthma Deaths. Providence, RI: Brown University, Dee 4, 1985. 2. Ma&on&l JB, Seaton A, Williams DA. Asthma deaths in Cardiff 1963-1974: 90 deaths outside hospital. Br Med J 1976;1:1493. 3. Kelson SG, Kelson DP, Fleegler BF, Jones RC, Rodman T. Emergency room assessmentand treatment of patients with acute asthma. Am J Med 1978;M:622.
Pulmonary and allergy specialists in general have of * Mys in whi& tmatment a@ modalities can be t tzdTfs&vely titize&uminimize the risk of asthma-Elated m&id&y and &&II. Although individual patients and physiciansin other specialties m edwCation
mu&y is could he itit&ed
ona na&&& level, a I&
iever, or
There is clearly a pharmacologic basis for asthma mortality, but whether there is a pharmacologic basis for increased asthma mortality is not known. It is not difficult, however, to envision a subtle pharmacologic basis for increases in asthma mortality, related to the way in which drugs are used in the treatment of asthma. Such an effect has been recognized in the United Kingdom when patient and physician management of asthma has been less than optimal.’ There are probably far too many physicians in the United States as well who do not appreciate current concepts on the treatment of asthma, especially as they relate to the use of corticosteroids and cromolyn sodium and the individualization of treatment with theophylline. This may be a manifestation of the tendency to place too much reliance on primary care physicians or others not specialized in the care of patients with asthma. There is also pressure on primary care physicians to accept total responsibility for patient care and to utilize referral systems sparingly. Primary responsibility for patient management is often relegated to nonphysicians as well. Pressure for shorter hospital stays could conceivably be associated with the relatively high risk of acute asthmatic relapse
In order to minimize the risk of murbidity and death induced by asthma, it will be necessary (1) to make sure that patients with asthma and the physicians who treat them are familiar with the optimal management of asthma, (2) to expand research on the pharmacologic.basis of such adverse events, and (3) to improve collection and hand&g of data to clarify the possible pharmacologic basis for increases in asthma-related deaths. 438
and death in the 2-week period after the patient leaves the hospital. ‘. ’ What is the adequacy of pharmacologic treatment for “new” groups in this country, such as the increasing number of Asian patients, or for other groups for whom language barriers may exist? To what degree does distraction of patients from appropriate to inappropriate care and/or inability of patients to afford adequate pharmacologic management contribute to asthma mortality? Certainly, there are many questions that remain to be answered before it will be possible to reach definitive conclusions about the degree to which pharmacologic management of asthma directly or indirectly contributes to asthma mortality.
1. Stableforth DE. Asthma deaths in the United Kingdom. In: International Symposium on Status Asthmaticus and Asthma Deaths. Providence, RI: Brown University, Dee 4, 1985. 2. Ma&on&l JB, Seaton A, Williams DA. Asthma deaths in Cardiff 1963-1974: 90 deaths outside hospital. Br Med J 1976;1:1493. 3. Kelson SG, Kelson DP, Fleegler BF, Jones RC, Rodman T. Emergency room assessmentand treatment of patients with acute asthma. Am J Med 1978;M:622.
Pulmonary and allergy specialists in general have of * Mys in whi& tmatment a@ modalities can be t tzdTfs&vely titize&uminimize the risk of asthma-Elated m&id&y and &&II. Although individual patients and physiciansin other specialties m edwCation
mu&y is could he itit&ed
ona na&&& level, a I&
iever, or