Asthma--contrasts in care.

Seaton, A

doi:10.1136/thx.33.1.1-a

Cited by 44 publications

(6 citation statements)

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“…Oral and inhaled corticosteroids and the severity of the fatal attack and delayed summoning help.5 A leading article on asthma in Thorax in 1978 said, "in almost no other field is the gap betweeen diagnostic and therapeutic knowledge and its general application so great." 6 We observed in our general clinical practice that many of these factors also applied to patients treated for acute attacks of asthma in hospital and sent home. A pilot retrospective survey of admissions for asthma to our hospital during 1983 suggested that corticosteroids were being underused in the management of asthma in hospital, many patients were discharged without any change in pre-existing treatment, and supervision of patients after the acute attack was inadequate.7 This survey also confirmed previous reports of resistance to use of the peak flow meter, an objective measure of airflow obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The index of venous tone rose at a mean rate of 0-23 (0-05) ml/dl over 40 mm Hg/hour during dialysis with acetate fluid (p<001) and 0-20 (0 05) ml/dl over 40 mm Hg/hour during dialysis with bicarbonate fluid (p<001). Vascular resistance in the forearm increased at a mean rate of [3][4][5][6] (1-12) units/hour during dialysis with acetate fluid (p<002) and [4][5] (1-48) units/hour during dialysis with bicarbonate fluid (p<0 01). There were no significant differences in the changes in venous tone or vascular resistance between dialysis with acetate and bicarbonate fluid.…”

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confidence: 99%

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Management of asthma in hospital: a prospective audit

Bucknall¹,

Robertson²,

Moran³

et al. 1988

BMJ

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with bicarbonate fluid (p<005). Mean arterial blood pressure fell at a mean rate of 3 9 (0 90) mm Hg/hour during dialysis with acetate fluid (p<001) and 1-4 (0 52) mm Hg/hour during dialysis with bicarbonate fluid (p<005). The rate of fall was significantly greater during dialysis with acetate than with bicarbonate fluid (p<0 02). The index of venous tone rose at a mean rate of 0-23 (0-05) ml/dl over 40 mm Hg/hour during dialysis with acetate fluid (p<001) and 0-20 (0 05) ml/dl over 40 mm Hg/hour during dialysis with bicarbonate fluid (p<001). Vascular resistance in the forearm increased at a mean rate of [3][4][5][6] (1-12) units/hour during dialysis with acetate fluid (p<002) and 4-5 (1-48) units/hour during dialysis with bicarbonate fluid (p<0 01). There were no significant differences in the changes in venous tone or vascular resistance between dialysis with acetate and bicarbonate fluid. DiscussionThe results of this study point to important abnormalities of the control of the peripheral circulation during dialysis that may contribute to the development of hypotension. The normal responses to a reduction in plasma volume such as that occurring during dialysis are venoconstriction and an increase in peripheral vascular resistance.7 Both of these mechanisms help to prevent a fall in blood pressure. The venoconstriction compensates for the reduced central plasma volume and maintains cardiac filling pressures and thereby cardiac output. The increase in peripheral vascular resistance helps maintain blood pressure despite a fall in cardiac output. Our patients showed a normal increase in peripheral vascular resistance during dialysis, but paradoxically their veins dilated. This venodilatation would accentuate the fall in central blood volume and lead to a fall in cardiac filling pressures and cardiac output and then to hypotension. Evidence supporting this as the mechanism of hypotension during dialysis is that an infusion of fluid often corrects the hypotension.The reason for the abnormal dilatation of the venous bed is unclear. It occurred equally during both types of dialysis and therefore is not due to the vasodilating properties of acetate. It does not seem to be due to autonomic dysfunction as there were appropriate changes in heart rate and peripheral resistance during dialysis, and the veins actively dilated. It is more likely that the correction of the metabolic derangements of renal failure withdrew a stimulus to venoconstriction. Whatever the mechanism, simple measures-for example, wearing support stockings-aimed at reducing pooling of blood in peripheral veins may prevent hypotension induced by dialysis.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Management of asthma in hospital: a prospective audit

Bucknall¹,

Robertson²,

Moran³

et al. 1988

BMJ

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“…This observation suggests either that the disease was mild before the life threatening attack or that both the patients and their general practitioners underestimated the severity of the disease. Hargreaves has shown that up to 77% of asthmatic patients have a reduced perception of the severity of airway obstruction, while Seaton has emphasised the underuse by doctors of objective measurements of airflow obstruction.9 10 On 29 out of 34 occasions (86%) the life threatening attack evolved over days rather than hours. This implies that there was time in which treatment could have been adjusted to cope with increasing symptoms.…”

Section: Discussionmentioning

confidence: 99%

Acute severe asthma treated by mechanical ventilation: 10 years' experience from a district general hospital.

Luksza¹,

Smith²,

Coakley³

et al. 1986

Thorax

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The procedure produced a rise in effective static compliance from a mean of 17 (SD 6) ml/cm H20 to 24 (9) ml/cm H20 at four hours. Bronchial lavage was associated with a significant excess of respiratory infections. A feature common to most patients was undertreatment before admission to hospital.Although the hospital mortality from acute severe asthma is less than 1% 1 mechanical ventilation (intermittent positive pressure ventilation: IPPV) is life saving in a few patients. We have reviewed the efficacy and safety of IPPV and therapeutic bronchial lavage in the management of acute severe asthma in a district general hospital. Furthermore, we have analysed the pattern of asthma before IPPV in an attempt to identify preventable factors.

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“…Rifampicin, with isoniazid and ethambutol, allowed us to treat more patients with TB outside hospital and reduce the length of treatment. The management of asthma (which appeared to be increasing in prevalence and associated with greater mortality) was greatly improved by inhaled corticosteroids and selective β-agonists, although Thorax drew attention to the generally poor quality of asthma care 18. Physicians were increasingly interested in chronic airflow obstruction, with Lane and Howell, and Leaver et al contributing to our understanding of the underlying pathophysiology 19 20.…”

Section: The Middle Years: 1970–1980mentioning

confidence: 99%