Severe status asthmaticus: Prolonged treatment with assisted ventilation

Reisman, Robert E.; Friedman, Irwin; Arbesman, Carl E.

doi:10.1016/0021-8707(68)90006-3

Cited by 20 publications

(6 citation statements)

References 18 publications

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“…Sobol, Emirgil, Wadhwani & Goyal (1972) followed 32 patients with chronic obstructive pulmonary disease for 4 to 32 months (average 18 months) who used an isoprenaline nebulizer at least 5 times/day and found that bronchodilator effects did not diminish. Ayres (1973) (Keighley, 1966;Reisman et al, 1968;Van Metre, 1969). There are also some patients whose condition may deteriorate when such aerosols are used (Keighley, JournalT (1972) points out that in cases of status asthmaticus 'Bronchodilator aerosols have ceased to be effective' and 'Sympathomimetic bronchodilators, by inhalation or by injection, should be avoided unless oxygen can be administered at the same time.'…”

Section: Discussionmentioning

confidence: 99%

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Lack of Cardiac or Bronchodilator Tachyphylaxis to Isoprenaline in the Dog

Minatoya

Spilker

1975

British J Pharmacology

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Tachyphylaxis to heart rate and bronchodilator effects of (±)‐isoprenaline was studied in anaesthetized open‐chest dogs by 5 procedures. Heart rate responses to a series of intravenous injections of isoprenaline were essentially unchanged before and after a 15 min infusion of isoprenaline (at 3 doses). Heart rate and bronchodilator responses in the same animal to an intravenous injection of isoprenaline were not significantly different before and after a 30 min infusion of isoprenaline (at 2 doses). Heart rate responses were relatively constant to an isoprenaline injection given every 30 min during a 4 h infusion of isoprenaline (at 3 doses), but the magnitude of the response was smallest for the largest infusion dose (highest background heart rate) and greatest for the smallest infusion dose (lowest background heart rate). Heart rate and bronchodilator responses in the same animal to isoprenaline were relatively constant during a 5 h infusion of isoprenaline (at 2 doses). Bronchodilator responses to intratracheally administered isoprenaline aerosol were essentially unchanged during a 4–5 h period using various doses and procedures. Tachyphylaxis to the heart rate or bronchodilator effects of isoprenaline was not observed. The present data give no support to the hypothesis that tachyphylaxis to isoprenaline aerosols is an important mechanism in asthma mortality.

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Section: Discussionmentioning

confidence: 99%

“…Some asthmatic patients were reported to have, no bronchodilator response to nebulized isoprenaline (Reisman, Friedman & Arbesman, 1968; Van Metre, 1969;Herxheimer, 1969Herxheimer, , 1972a. It is not certain whether this lack of response was due to tachyphylaxis or to other causes (see Discussion).…”

Section: Introductionmentioning

confidence: 99%

Lack of Cardiac or Bronchodilator Tachyphylaxis to Isoprenaline in the Dog

Minatoya

Spilker

1975

British J Pharmacology

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“…They suggested that in asthmatic patients who use sympathomimetic pressurized aerosols excessively cross-resistance develops to both exogenous sympathomimetic amines and to the natural transmitter release by the adrenergic nerves, and that this may lead to a deterioration of the asthmatic state and explain the rise in the asthma mortality rate. The cross-tolerance experiments decribed here may explain the good results which were obtained only after the withdrawal of adrenergic bronchodilator therapy from some asthmatic patients (Keighley, 1966;Reisman, Friedman & Arbesman, 1968).…”

Section: Cross-tolerance Studiesmentioning

confidence: 65%

“…It has been suggested (Robison, Butcher & Sutherland, 1967;Robison, Butcher & Sutherland, 1971) that the ,B-adrenoceptor is a component of the enzyme adenyl cyclase and that catecholamines stimulate adenyl cyclase to increase the formation of intracellular cyclic 3',5 '-adenosine monophosphate (cyclic AMP) from adenosine triphosphate (ATP) and that this causes relaxation of the smooth muscle of the bronchi.…”

Section: Mechanism Of the Development Of Tolerancementioning

confidence: 99%

TOLERANCE TO SYMPATHOMIMETIC BRONCHODILATORS IN GUINEA‐PIG ISOLATED LUNGS FOLLOWING CHRONIC ADMINISTRATION in vivo

Benoy

Elfellah

Schneider

et al. 1975

British J Pharmacology

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Pretreatment of the guinea‐pig subcutaneously three times daily with either 5 μg/kg isoprenaline or adrenaline reduced the response of the isolated perfused histamine‐constricted lung when challenged with either the same or a different sympathomimetic bronchodilator. The longer the animals were pretreated and the higher the dose of bronchodilator the greater was the degree of tolerance developed. Tolerance was developed to aminophylline in the same preparation when the guinea‐pig had been pretreated with aminophylline or isoprenaline. Cross‐tolerance also developed to adrenaline when the guinea‐pig had been pretreated with aminophylline. Tolerance was still persistent in guinea‐pigs one and two weeks after pretreatment three times daily with either isoprenaline or adrenaline (5 μg/kg s.c.) for seven days in the same preparation. Only after three weeks was the tolerance diminished. These results suggest that asthmatic patients who use bronchodilators excessively may become refractory to the bronchodilator effect of these drugs. They also support the hypothesis that induced cross‐resistance to endogenous sympathetic stimulation could lead to a deterioration of the asthmatic state in patients using the sympathomimetic bronchodilators and that this may explain the increase in asthma mortality rate. A mechanism of tolerance to sympathomimetic bronchodilators is postulated.

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“…No effect on by mechanical ventilation at a much earlier time, sputum production, PEF or arterial blood gases Moreover, Reisman et al (109) could not dewas shown.…”

Section: Intravenous Aminophylline and Intravenousmentioning

confidence: 99%

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1981

Allergy

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Asthma has proved difficult to define (42, 103, in asthma often comes suddenly and unexpect-116) and physicians do not always agree about edly, and even experienced physicians may when a patient should be called asthmatic, have difficulty in judging the severity of an Status asthmaticus cannot be easier to define, attack. The patient may be a better judge in but it seems much more seldom that physicians this respect (122), but many asthmatics are not disagree about a diagnosis of status asthma-very sensitive to changes in airway obstruction, ticus. The term will be used here to denote a Rubinfeld & Pain (111) found that 15% were sustained attack of severe asthma that has not unable to sense a reduction in FEVj below 50% responded to the treatment administered by of predicted value. An objective assessment the patient and his doctor. It is a serious and ought usually to be the first step taken when potentially lethal phase of the disease and if dealing with a patient in status asthmaticus. It hospital admission is possible it will usually be can be carried out in a few minutes, and it required.provides both a baseline from which the proStatus asthmaticus is an acute aggravation gress of the patient can be assessed and a gradwhich may afflict the allergic as well as the ing of the severity of the attack, non-allergic asthmatic. It may occur at any age.The physical signs of wheezing, the use of but the risk seems to be greatest in the middle-accessory respiratory muscles and the presence aged patient with asthma of late onset. It also of pulsus paradoxus have not been found to be seems to afflict women more often than men. reliable indicators of the severity of asthma (71, In seven recent papers (7,25,58,61,70,118,121). 119) out of a total of 1,540 patients, 1,136 were Counting the heart rate is the simplest of females and 404 males, i.e. a ratio of about 3:1.objective measurements and will provide some We have now fairly good knowledge of the indication of the severity of the attack. An elecliberation of mediator substances from the trocardiogram and a chest radiograph should mast cell in the reaction with specific allergens also be available. Tachycardia is always a feature and about their possible significance in acute, of severe asthma and is related to the degree of asthmatic attacks. Yet we do not understand hypoxaemia (107). The average heart rate is what happens when the patient lapses into about [120][121][122][123][124][125][126][127][128][129][130] found an average status asthmaticus despite the use of the medi-rate of 126; Westerman (137) 139 with a range cation which in other situations has successfully from 110 to 180; Rees (107) 118, range 96-160. brought him relief Cooke et al. (25) found a heart rate above 90 in 87% of their patients and that 75% of the complications occurred in patients with a heart Objective assessment ^ , ,0•^ rate above 130. The treatment of severe asthma must reasonTwo important objective measurements that ably begin with an assessment of severity. Death any emergency ward s...

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Severe status asthmaticus: Prolonged treatment with assisted ventilation

Cited by 20 publications

References 18 publications

Lack of Cardiac or Bronchodilator Tachyphylaxis to Isoprenaline in the Dog

Lack of Cardiac or Bronchodilator Tachyphylaxis to Isoprenaline in the Dog

TOLERANCE TO SYMPATHOMIMETIC BRONCHODILATORS IN GUINEA‐PIG ISOLATED LUNGS FOLLOWING CHRONIC ADMINISTRATION in vivo

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