A Cuban experience in the Management of severe Asthma.
The clinical review entitled Difficult to Treat Asthma in Adults, published on 24 February 2009 by Graeme P Currie, J Gram. Douglas and Liam G Heaney was analyzed and discussed by our clinical staff at the Gustavo Aldereguía Hospital in Cuba. This review has been of great interest for all of us because of the broad and clear explanation presented in regards with the diagnostic and therapeutic management of Bronchial Asthma.
In our response to the article we offer the results of the experience of some Cuban doctors with in-patients who suffer from severe Asthma attacks at the Intensive Care Unit of the same institution. It gives medical assistance to about 400,000 inhabitants. The prevalence of Bronchial Asthma in this southern and central city of the Cuban island is 8.0%
Bronchial Asthma is a disease that presents in patients with greater etiopathogenic evidences. Bronchial hyper reactivity is still the most lethal combination of symptoms and signs in spite of all the medical efforts doctors carry out in the diagnosis and treatment of this entity either in the inter crisis period or in the exacerbation of the acute phase. As Cuban doctors from this hospital have devoted time to treat patients in such a condition, this summary shows some positive findings related to this Cuban experience.
In a series of 75 severely ill patients admitted at the Intensive Care Unit (ICU) in the year 2006 with a diagnosis of acute asthma attack , the treatment prior to admission was mainly directed to Hydration (89,3%), Theophyline (100%), IV Steroids (80,0%) and Beta stimulating aerosols (72%). After their admission at the ICU, there was an increase in the use of IV rehydration (100%), IV Steroid (89,3%), Antibiotics ( 49,3%)and I.V Betastimulating drugs were introduced for the first time in 76,6% of the patients.
The clinical classification used at this institution while determining he severity of the condition and its corresponding system of urgency is the classification established by Millar and green in 1994.
Other results from this experience are related to the mortality rate in a series of severely ill patient with Asthma crisis who were ventilated for 5 years (2002-2006). The mortality rate during that period was 12,5 % similar to the rate reported by Andersen in 1988 (12,3%) and higher than the mortality rate reported by Scoggine in 1977 (9,5%) and lesses to Sisald´s rate reported in 1969 (13,7%).
As can be seen, the mortality rates in ventilated asthmatic patients have not been reduced in the last 4 decades, although there are safer and more diverse mechanical ventilators and diverse therapeutical alternatives for the management of this pathology in order to face brochoconstriction. Therefore, strategies should be directed to the early treatment of the crisis and to the appropriate treatment as well as to the efficient management of patients in the inter crisis period if the aim is to diminish the appearance of severe asthma in the medical institutions.
References:
1. Currie GP, Douglas JG, Heaney LG. difficult to treat asthma in adults. BMJ 2009; (338): b494.
2. Hall I, Genetics of asthma. Clin Asthma Rev 1997; (1): 39-44.
3. Burney PGJ, Britton JR, Chinn S. Is asthma correlate with salt intrake?. BMJ 1986: (292): 1483.
4. Van Schaychk CP, Dompleng E, Van Herwaarden C. Bronchodilatator treatment in moderate asthma or chronic bronchitis: continuous or demand? A randomized controlled study. BMJ 1991; (303): 1426-31.
Rapid Response:
A Cuban experience in the Management of severe Asthma.
The clinical review entitled Difficult to Treat Asthma in Adults, published on 24 February 2009 by Graeme P Currie, J Gram. Douglas and Liam G Heaney was analyzed and discussed by our clinical staff at the Gustavo Aldereguía Hospital in Cuba. This review has been of great interest for all of us because of the broad and clear explanation presented in regards with the diagnostic and therapeutic management of Bronchial Asthma.
In our response to the article we offer the results of the experience of some Cuban doctors with in-patients who suffer from severe Asthma attacks at the Intensive Care Unit of the same institution. It gives medical assistance to about 400,000 inhabitants. The prevalence of Bronchial Asthma in this southern and central city of the Cuban island is 8.0%
Bronchial Asthma is a disease that presents in patients with greater etiopathogenic evidences. Bronchial hyper reactivity is still the most lethal combination of symptoms and signs in spite of all the medical efforts doctors carry out in the diagnosis and treatment of this entity either in the inter crisis period or in the exacerbation of the acute phase. As Cuban doctors from this hospital have devoted time to treat patients in such a condition, this summary shows some positive findings related to this Cuban experience.
In a series of 75 severely ill patients admitted at the Intensive Care Unit (ICU) in the year 2006 with a diagnosis of acute asthma attack , the treatment prior to admission was mainly directed to Hydration (89,3%), Theophyline (100%), IV Steroids (80,0%) and Beta stimulating aerosols (72%). After their admission at the ICU, there was an increase in the use of IV rehydration (100%), IV Steroid (89,3%), Antibiotics ( 49,3%)and I.V Betastimulating drugs were introduced for the first time in 76,6% of the patients.
The clinical classification used at this institution while determining he severity of the condition and its corresponding system of urgency is the classification established by Millar and green in 1994.
Other results from this experience are related to the mortality rate in a series of severely ill patient with Asthma crisis who were ventilated for 5 years (2002-2006). The mortality rate during that period was 12,5 % similar to the rate reported by Andersen in 1988 (12,3%) and higher than the mortality rate reported by Scoggine in 1977 (9,5%) and lesses to Sisald´s rate reported in 1969 (13,7%).
As can be seen, the mortality rates in ventilated asthmatic patients have not been reduced in the last 4 decades, although there are safer and more diverse mechanical ventilators and diverse therapeutical alternatives for the management of this pathology in order to face brochoconstriction. Therefore, strategies should be directed to the early treatment of the crisis and to the appropriate treatment as well as to the efficient management of patients in the inter crisis period if the aim is to diminish the appearance of severe asthma in the medical institutions.
References:
1. Currie GP, Douglas JG, Heaney LG. difficult to treat asthma in adults. BMJ 2009; (338): b494.
2. Hall I, Genetics of asthma. Clin Asthma Rev 1997; (1): 39-44.
3. Burney PGJ, Britton JR, Chinn S. Is asthma correlate with salt intrake?. BMJ 1986: (292): 1483.
4. Van Schaychk CP, Dompleng E, Van Herwaarden C. Bronchodilatator treatment in moderate asthma or chronic bronchitis: continuous or demand? A randomized controlled study. BMJ 1991; (303): 1426-31.
Competing interests:
None declared
Competing interests: No competing interests