A review of 30 years of life-threatening asthma cases in a San Antonio intensive care unit found that annual ICU admissions for the condition have dropped 74%. The study, by University of Texas (UT) Medicine San Antonio physicians who reviewed cases at University Hospital between 1980 and 2010, also showed intubation in the emergency department to help patients breathe did not result in longer hospital stays.
The findings appear in the journal Respiratory Medicine.
The researchers studied inpatient care of status asthmaticus at University Hospital. Patients with this condition experience respiratory failure because their asthma is not responding to standard therapies.
The research team extracted all notes and orders from an electronic medical record, showing that 227 patients were admitted to the medical intensive care unit with 280 episodes of status asthmaticus over the three decades. The hospital analysis showed only one death, and it was of a different cause after the asthma improved.
"The main reason for the decline in cases is that more of our patients are taking their controller medications such as inhaled corticosteroids, which reduce the amount of inflammation in the airways," said Jay I. Peters, MD, lead author of the study and professor and chief of pulmonary diseases in the School of Medicine.
In a separate study of 1,000 children and adults, 70% of asthma patients reported routinely taking their corticosteroids. Peters credited this high rate of compliance to asthma education programs provided in neighborhood clinics, including patient care facilities in the University Health System.
"Studies show if you use your corticosteroid at least 11 months out of the year your risk of dying from asthma comes down exponentially," Peters said. "Many times asthmatics don’t comply because they feel fairly good on a daily basis, but the steroids reduce the risk of exacerbations and death."
Peters and his team also looked at intubation rates for asthmatics at University Hospital, given that many pulmonary physicians thought too many asthmatics were intubated in emergency departments, leading to longer hospital stays. Previous studies in the medical literature concluded asthmatics should not be intubated because of increased risk of complications such as pneumonia.
In the San Antonio study, patients were intubated either because they quit breathing or their carbon dioxide levels had risen dangerously. According to the data, few patients suffered complications after being intubated.
"I think our methods of treating patients in the emergency department have improved so much that previous studies of issues with intubation don’t hold up anymore," Peters said.
"On the front end, this study reinforces the importance of staying on controller medications," he said. "On the back end, it shows low mortality for patients in the medical ICU and that we don’t need to be afraid to intubate patients and place them on mechanical ventilation if necessary."
Source: University of Texas Health Science Center at San Antonio
