| Popis: |
A fundamental question may be proposed. Does the higher frequency of asthmatic deaths mean an increase in the severity of the asthma? Many authors think it possible. Alexander5 describes three epochs in the evolution of the frequency of these deaths. In the first epoch, the asthma cases were allergic and atopic and were somewhat light, and the observations of fatal cases were rare. In the second one, around 1930, fatal cases became more frequent, due to the fact that the infectious type was added. (These latter cases, even though having a similar symptomatology, are somewhat more severe and the asthma lasts longer; they very easily evolve toward fatal complications.) Finally, in a third epoch from 1953 up to the present time, again the frequency of fatal cases has decreased, possibly due to the use of the adrenal corticoids, ACTH, antibiotics, and other therapies. The evolution of these three epochs looks somewhat doubtful to us but it is so evident that the frequency of death among patients with an "asthmoid" background has increased. We have gathered, at our clinic, 33 fatal cases out of which three were observed from 1940 to 1954, and the other 30 have been observed in the last ten years, among 2,225 (1.3%) asthmatic patients. A review of the latter cases, searching the possible causes of differences between fatal and non-fatal termination, shows two factors. In the first place, it is a matter of different types which have been considered jointly, due to the common presence of respiratory dyspnea, which may have seasons of varying intensity, and which also respond, more or less speedily, to the comparable therapy (adrenalin, Isuprel, Euphiline, glucocorticoids) . In the second place, in the serious cases we now have many therapeutic measures which require hospitalization (aspiration, controlled respiration, etc.) This makes it possible that more and * This paper was submitted as part of the M. M. Peshkin Commemorative Volume. |
