| Summary: | Physicians are very much concerned that death from asthma has not significantly declined despite modern treatment. Since most asthma deaths take place at home it is mandatory to keep in mind that adequate management should be commenced as early as possible at home when a severe asthmatic attack develops especially in high-risk patients.
For preventive care, the main objective should be to avoid severe hypoxemia with resultant cardiac arrest that may occur during severe asthmatic attacks at home and during transportation.
A total of 97 patients were studied with near-fatal asthmatic attacks requiring mechanical ventilation at least once during the period from January 1979 to November 1993, these patients were seen at Okinawa Chubu Hospital and survived without significant morbidity.
They were considered at high risk for recurrence of life-threatening asthmatic attacks and death and were therefore persuaded to undergo a trial of immediate self-oxygenation at home and during transportation to an emergency department whenever a severe attack developed.
Only 61 patients agreed to our request. Among those who agreed to install home oxygen, 24 subsequently developed severe attacks requiring mechanical ventilation outside hospital during following 15 years. Sixteen of them immediately started oxygenation at home in addition to the anti-asthma medication, continuing the process all the way to emergency center; all survived.
Eight Patients did not actually take their home oxygen and four of them died p<0.05).
Among the 36 patients who declined home oxygen trial, 13 experienced recurrences of severe asthmatic attacks outside the hospital ; nine of them died.
Long-term follow up disclosed that 8.1 percent of those receiving home oxygen offered to them (n=61) died from an asthmatic attack. On the other hand, 30.5 percent of those who refused to have home oxygen (n=36) died within a 15 years period (p<0.05).
|
|---|
