INVESTIGATION OF A CLUSTER OF DEATHS OF ADOLESCENTS FROM ASTHMA - EVIDENCE IMPLICATING INADEQUATE TREATMENT AND POOR PATIENT ADHERENCE WITH MEDICATIONS
INVESTIGATION OF A CLUSTER OF DEATHS OF ADOLESCENTS FROM ASTHMA - EVIDENCE IMPLICATING INADEQUATE TREATMENT AND POOR PATIENT ADHERENCE WITH MEDICATIONS
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DOI：
10.1016/0091-6749(89)90361-8
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发表时间：
1989-10-01
影响因子：
14.2
通讯作者：
TEUTSCH, S
中科院分区：
文献类型：
--
作者：
BIRKHEAD, G;ATTAWAY, NJ;TEUTSCH, S
我们调查了1987年圣路易斯市3个月内5例青少年哮喘死亡病例。尽管该集群代表了该年龄组中哮喘死亡人数比前几年观察到的统计学显著增加，但无法确定对环境、传染性或治疗剂的共同暴露。社区两所儿科医院的哮喘住院和急诊就诊模式并没有表明在此期间哮喘的频率或严重程度增加。尽管缺乏证据表明死者有共同的接触，但他们有许多共同的个人和医学特征。所有死者都是黑人患者，社会经济地位较低。所有人都是青少年，负责调节自己的药物时间表。医务人员和患者家属显然缺乏对哮喘严重程度的认识。例如，两名患有严重哮喘的患者没有接受吸入性皮质类固醇。此外，4例受试死亡动物在致死性发作时测得的血清茶碱水平明显低于治疗水平或为零，即使处方了适量的茶碱。他们的茶碱水平大大低于同一时期在急诊室或因哮喘住院的同龄患者的水平。继续努力教育青少年患者，他们的家人和医疗保健提供者有关哮喘的治疗是必要的。
We investigated a cluster of five deaths of adolescents from asthma in St. Louis during a 3-month period in 1987. Although the cluster represented a statistically significant increase in the number of asthma deaths in this age group over that observed in previous years, no commmon exposure to environment, infectious, or therapeutic agents could be identified. The patterns of hospital admissions for asthma and emergency room visits at the two pediatric hospitals in the community did not suggest an increase in the frequency or severity of asthma during this time. Despite the lack of evidence for common exposure, the decedents shared many personal and medical characteristics. All decedents were black patients and were of lower socioeconomic status. All were adolescents and were responsible for regulating their own medication schedules. Lack of appreciation of the severity of their asthma by medical personnel and the patients'' families was evident. For example, two patients with severe asthma had not been prescribed inhaled corticosteroids. In addition, the four decedents tested had markedly subtherapeutic or zero serum theophylline levels measured at the time of the fatal episode, even though appropriate amounts of theophylline had been prescribed. Their theophylline levels were substantially lower than levels in patients of the same age observed at the emergency room or hospitalized for asthma during the same time period. Continued efforts to educate adolescent patients, their families, and medical care providers about the treatment of asthma are warranted.