Asthma deaths

In June 1967, the Committee of Safety in Medicines (41) issued a warning about the need for care in prescribing and using aerosols, emphasizing their great 

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The lesson that must not be forgotten is that any new treatment must be introduced gradually and under close supervision. The importance of pharma-covigilance and reporting cases of possible toxicity cannot be overemphasized. 

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Lanes SF, Garcia Rodriguez LA, Huerta C. (2002) Respiratory medications and risk of asthma death. Thorax. 57, 683-686. 

During infancy, wheezing is also associated with the sequestering of CD8+ cells in the airways during an acute asthma attack, and asthma deaths are associated with activated CD8+ T-cell infiltration into peribronchial tissue. 

In a report the manufacturers have discussed the epidemiological data linking the use of fenoterol to asthma mortahty in New Zealand. They pointed out that asthma mortahty started to fall in 1979 while fenoterol sales were stiU increasing. Sales of fenoterol in Austria, Belgium, and Germany were similar to those in New Zealand at the peak of the New Zealand asthma death epidemic, but asthma mortality in the other countries did not rise. The confounding problem that fenoterol was preferentially prescribed for the more severe cases of asthma was... 

It is interesting to reflect that a similar debate followed the rise in asthma deaths in the UK in the 1960s. Most physicians now accept that excessive use of beta-adreno-ceptor agonists in worsening asthma indicates inadequate treatment rather than a toxic effect of the drugs. 

The bronchial histopathology of patients who have died of asthma shows an intense infiltration of the bronchial mucosa with inflammatory ceUs, particularly eosinophils, macrophages, lymphocytes and to a lesser extent neutrophils. Deposition of eosinophil products in the bronchial epithelium and subepithelium is a particularly prominent feature (Filley etal., 1982). Epithelial denudation, dilatation of blood vessels, mucosal oedema and hypertrophy of both submucosal glands and bronchial smooth muscle are other features. Many of these features of asthma deaths are also observed in milder and well-controlled asthmatics. Elevated numbers of eosinophils, moncytes/macrophages and activated lymphocytes are persistent features observed in bronchial biopsies... 

Although both the prevalence and the morbidity from asthma are increasing, the death rate from asthma in the United States appears to have reached a plateau of about 5000 deaths per year and may be on the decline. Despite the relatively low number of asthma deaths, 80% to 90% are preventable. Most deaths from asthma occur outside the hospital, and death is rare after hospitalization. The most common cause of death from asthma is inadequate assessment of the severity of airways obstruction by the patient or physician and inadequate therapy. The most common cause of death in hospitalized patients is also inadequate or inappropriate therapy. Thus the key to prevention of death from asthma, as advocated by the NAEPP, is education. ... 

The most important development in antiasthma drug delivery was the advent of the metered-dose inhaler in 1956, which resulted in a huge increase in the use of antiasthma therapy. Sales of pressurized metered-dose inhalers now run at approximately 500 million per year. However, the introduction of this device was not without problems. This section of the chapter covers the early use of propellants in atomization, the origin of the metered-dose inhaler, and the epidemic of asthma deaths. 

Figure 10 The rise and fall in death rates during the epidemic of asthma deaths was mirrored by the rise in sales of pressurized metered-dose aerosol inhalers. (From Ref. 42.)...

Baclofen, withdrawal syndrome, 26.152 Bambuterol, cardiac failure, 23.181 Benzodiazepines brain damage, 14.36 dependence, 12.41 depression, 17.43 medicolegal aspects, 13.33 Beta2-adrenoceptor agonists, 18.159 asthma, 19.178, 21.179 asthma deaths, 17.164 long-acting, respiratory adverse effects,... 

The 4,000 asthma deaths and 20,000 cancer cases estimated from home-related exposures are eightfold larger than the 3,000 cancer cases estimated for 20 toxic air pollutants and all Superfund sites. The 50,000,000 injuries/ yr in the U.S. from lead and allergic disease in the home can only be compared with the total health damage from ambient air and water pollution. However, it will be difficult to establish or change environmental and personal priorities on the basis of these opportunities for risk reduction if the public and our leaders are unaware of them. 

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