Deaths in Asthma: A Therapeutic Misadventure?

The management of acute severe asthma

“…Indeed the mortality curve for asthma closely resembled the curve for sale of aerosols (Speizer et al, 1968;Heaf, 1970;Stolley & Schinnar, 1978). Clark (1983) suggests that increased bronchodilator consumption, when associated with increased asthma fatalities, is more likely to indicate an excessive dependence on bronchodilators by patients and clinicians at times when asthma control is failing.…”

“…Numerous retrospective surveys of asthma mortality have shown that up to 80% ofdeaths were 'sudden and unexpected' (Speizer et al, 1968;Heaf, 1970;Fraser et al, 1971). Many occurred outside hospital (Cochrane & Clark, 1975, Wilson et al, 1981.…”

Evolving ways that drug therapy is individualized

“…The classic example of the value of this approach is demonstrated by the recognition that thalidomide was the cause of phocomelia and the abrupt end to the epidemic of phocomelia when thalidomide was withdrawn 3 . The association of high‐dose inhaled adrenergic agonists with increased death from asthma led to the withdrawal of these specific products and a reduction in the asthma death rate 23 . Another example of how pharmacovigilance was used to tailor drug therapy is from Finland.…”

“…3 The association of high-dose inhaled adrenergic agonists with increased death from asthma led to the withdrawal of these specific products and a reduction in the asthma death rate. 23 Another example of how pharmacovigilance was used to tailor drug therapy is from Finland. There was widespread use of erythromycin for treating skin and respiratory infections in outpatients.…”

The physiology and management of childhood asthma

“…They have relatively little or no effect on the fixed component and are relatively ineffective when this predominates (Group 3). Indeed they may be dangerous if given repeatedly to these subjects on account of their cardiac action (Heaf, 1970). They are indicated primarily in Groups 1 and 2 asthma.…”