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ASTHMA: Kuo C. Chang, William M. Vollmer, Michael J. Barrett, Robert Lawrence, Kenneth M. Ettinger, Jean M. Carney, and Fredrick F. Gill Prolonged Episodes of Persistent Asthma: A Distinct Clinical Pattern With Characteristic Clinical Features Chest 2000; 117: 944-949 [Abstract] [Full text] [PDF]

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Re: Prolonged Episodes of Persistent Asthma

S K Agarwal   (27 June 2000)

Re: Prolonged Episodes of Persistent Asthma 27 June 2000
S K Agarwal Department of Chest Diseases, Banaras Hindu University, Varanasi 221 005, India Send letter to journal: Re: Re: Prolonged Episodes of Persistent Asthma sk_agarwal{at}satyam.net.in S K Agarwal	The authors [1] studied 18 subjects who had two or more prolonged episodes of unexplained persistent asthma lasting > 2 months during a 12-year period and found infection of the upper respiratory tract as the important triggering factor. However, it is important to distinguish between the factors that either predispose to or cause asthma and those factors which, in a patient already suffering from asthma, contribute to loss of control of asthma. The authors, surprisingly, have not mentioned about gastro-oesophageal reflux (GER) in these patients. Gastro-oesophageal reflux is commonly noted in asthmatics and significant improvement in asthma has been observed when concomitant GER disease has been treated. Another important factor about which authors have not mentioned is, psychosocial. Psychosocial factors, which may be linked with or compounded by poor patient compliance and lack of appropriate medical care [2] have been implicated in retrospective analyses of asthma deaths. High scores of psychiatric morbidity have been correlated with persistent asthma. It is not clear from the present study [1] about the patient compliance/adherence to treatment prescribed. As it has been found that compliance to inhaled corticosteroid therapy in asthma is 30 to 70% [3]. The use of electronic monitors on inhalers, should ideally form part of the assessment of the patient with persistent asthma, not only for regular therapy but also for as needed therapy, such as inhaled short-acting beta2agonists. References : 1. Chang KC, Vollmer WM, Barret MJ etal. Prolonged Episodes of Persistent Asthma. Chest 2000;117:944-949 2. Miller BD, Strunk RC. Circumstances surrounding the deaths of children due to asthma. A case control study. Am J Dis Child 1989;143:1294-1299 3. Bosley CM, Parry DT, Cochrare GM. Patient compliance with inhaled medication: does combining beta-agonists with corticisteroids improve compliance ? Eur Respir J 1994;7:504-509.