A STUDY OF ASTHMA DEATHS IN A THIRD-LEVEL EMERGENCY CENTER

• Published in: Journal of The Showa Medical Association Vol. 58; no. 3; pp. 270 - 276
• Main Authors: OSAKABE, Yoshimi, TAKAHASHI, Yoshiki, SUZUKI, Hajime
• Format: Journal Article
• Language: English; Japanese
• Published: The Showa University Society 1998; 昭和大学学士会
• Subjects: asthma death; atopic type asthma bronchial; education of asthma; third-level emergency center; treatment of irregulary; アトピー型喘息; 三次救命救急施設; 不定期治療; 喘息教育; 喘息死
• ISSN: 0037-4342; 2185-0976
• DOI: 10.14930/jsma1939.58.270

In recent years, mortality from bronchial asthma has increased in industrialized countries. The annual number of deaths from asthma in Japan is about 6, 000, which is somewhat higher than in other industrialized countries in Europe and North America. We, therefore, studied the causes of and the countermeasures against asthma deaths from the point of view of a third-level emergency. The subjects were patients with bronchial asthma who required eudotracheal intubation. Subjects were selected for this study from among patients who had been brought by ambulance to the emergency center of our hospital, which is a third-level emergency facility. The subjects were 92 patients with asthma who were hospitalized at our center during the 12 years from April 1985 through March 1997. Sixty-one patients required eudotracheal intubation (34 males and 27 females ; average age, 41.7±20.9) . Divided by type of asthma, 34 patients (55.7 % ) with an average age of 30.5±17.5 years had atopic (type A ) asthma and 27 patients (44.3 %) with an average age of 56.2±17.0 years had nonatopic (type NA) asthma. After receiving emergency care 30 patients (50.8 %) survived and 31 patients (49.2 %) died. Of the patients who died, 25 (80.6 %) had cardiopulmonary arrest on arrival. Deaths were particularly common among young patients with type A asthma. We examined the respiratory index (RI) to evaluate the severity of disease when patients were hospitalized. Patients who died had a poor RI. We then examined the time required for patients to be brought to the hospital (by ambulance only) ; we found that the time of transport had no effect on outcome. Thus, we concluded that the problems must have arisen before the patients were transported by ambulance. A survey of clinics and the patients' attitudes toward treatment showed that 78 % of patients who died had been treated by physicians and that 78 % had received treatment irregularly and at the time of asthmatic attacks. It was found that among patients who had been brought to third-level emergency facilities, young patients with type A asthma were more likely to die of asthma and had visited physicians on an irregular basis. Our retrospective study suggests that these physicians lacked sufficient knowledge of allergic diseases and failed to properly educate their patients about asthma and provide the most appropriate treatment during asthma attacks. We believe that deaths from asthma could be decreased by educating clinical physicians who treat asthma patients.