Chest
Volume 92, Issue 3, September 1987, Pages 460-466
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Clinical Investigations
Prevention of Fatal Asthma

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Over a 32-month period, 980 calls from asthmatic patients were received at the switchboard office of a prehospital emergency care unit. A total of 90 patients (9 percent) died before receiving any medical help, and 216 (22 percent) patients were taken to the hospital with an emergency care ambulance where none of them died. We made the assumption that, when an asthmatic patient calls an emergency care unit, the attack is severe and might be fatal. A prospective study was performed during a six-month period to prevent these asthma deaths: 259 calls from asthmatic patients were received. For each emergency call from asthmatic patients, paramedical help (delay: 5.1±0.3 minutes) and an emergency care ambulance (delay: 9.7±0.6 minutes) were immediately sent Only four patients died during this period. Emergency calls from asthmatic patients must be considered as related to a severe attack that might be fatal. Fatal asthma is often related to a severe attack that evolves rapidly. Some asthmatic patients are able to assess the severity of asthma attacks, and prehospital emergency care schemes for asthmatic patients are actually able to prevent some asthma deaths.

Section snippets

METHODS

The study involved two parts. A retrospective study was performed to analyze data from asthma deaths in our unit and to enable comparison with the prospective part of the study. Moreover, in order to confirm or show up the weakness of our assumption that patients who called our unit actually had a severe attack of asthma, peak-flow was systematically measured in asthmatic patients who called our unit.

RESULTS

Retrospective Study

Some 980 emergency calls from asthmatic patients were recorded during the study period. A total of 216 (22 percent) of these patients were taken to the hospital with an emergency care ambulance and none of them died.

Ninety (9.2 percent) asthmatic patients who called died; 36 asthmatic deaths occurred in 1983; 31 in 1984; and 23 from January to August 1985. A total of 21 (23 percent) patients were found in respiratory or cardiorespiratory arrest by their relatives or a

DISCUSSION

The results of our study suggest that the mortality rate of asthma was dramatically decreased, and that most asthma deaths are preventable. Nevertheless, we must admit that the patients who died and never called anybody were not counted in our study and that four patients died in spite of our scheme. Nevertheless, during a six-month period, 17 patients in circulatory or respiratory arrest were successfully resuscitated and were discharged alive from the hospital without sequellae.

The question

CONCLUSIONS

A better recognition of asthma, because failure to diagnose precludes effective treatment, education of asthmatic patients and all professionals likely to come into contact with asthma, and the development of self-referral admission services for asthmatic patients are probably necessary. But development of prehospital emergency care schemes are of paramount importance and may prevent some unnecessary deaths. Emergency calls from asthmatic patients must be considered as related to a severe

ACKNOWLEDGMENT

We wish to thank the staff of the Fire Brigade of Paris for their continuous help in this study. We are particularly indebted to Colonel René Noto, M.D., who controls the Emergency Medical Service of the Fire brigade of Paris and helped develop the prehospital scheme for asthmatic patients. We are indebted to Pr. Francois Clergue, M.D., and to Michel Aubier, M.D., for reviewing the manuscript and for their valuable advices. We are indebted to Françoise Neukirch for her assistance in statistical

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Manuscript received October 9; revision accepted February 26.

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