Oxygen should be first treatment given to patients with severe asthma

הסקירה באדיבות אתר מדיקונטקסו:By Steven Reinberg

LONDON (Reuters Health) – Calling for a change in the current treatment of acute severe asthma, UK researchers urge that oxygen to prevent hypoxaemia should the first treatment given.

Dr. David Inwald, from the Institute of Child Health, London, and colleagues performed a meta-analysis of 11 studies of adults and children with severe asthma. Their analysis revealed that hypoxaemia is a significant cause of death in cases of acute severe asthma, according to their report in the July 14th issue of the British Medical Journal.

Given this finding, Dr. Inwald's group believes that in cases of acute severe asthma, oxygen should be the first-line treatment. In addition, because nebulisation of ß2-agonists given with air can increase hypoxaemia, they recommend that ß2-agonists be administered with nebulised oxygen.

"The important point," Dr. Inwald's team stresses, "is that asthmatic patients are still dying during acute attacks–and the use of oxygen before, during, and after nebulised ß2-agonist therapy in primary care and in the community is rational and could save lives."

While treatment for mild and moderate asthma attacks should not be changed, Dr. Inwald and colleagues conclude that treatment for severe asthma attacks should be modified to include oxygen administration as standard therapy. "We urge the British Thoracic Society to review this issue when it updates its guidelines," they write.

However, another asthma specialist does not endorse this recommendation. The co-administration of oxygen will not make any difference asthma mortality "because the reason patients die is because they are not responding to the bronchodilator," Dr. John Condemi, from the University of Rochester in New York, told Reuters Health.

"Giving them oxygen will not prevent them from dying–you have got to control the asthma," continued Dr. Condemi, who is a clinical professor of medicine and AMA board certified in allergy and immunology.

Dr. Condemi did point out that in the emergency department oxygen is generally given first to asthma patients to help them feel better. However, there are no data, he added, that the oxygen given with the ß-agonist makes the ß-agonist work better; it may only prevent the normal small drop in oxygen that occurs during treatment.

"The cause of death is lack of oxygen, but it really occurs because you haven't opened up the airway," Dr. Condemi stressed.

BMJ 2001;323:98-100.

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