DEATHS FROM ASTHMA, WITH SPECIAL REFERENCE TO THE LAST DRUG TREATMENT

Abstract

Abstract. Fifty‐four patients who died from asthma in hospital in 1956–1967 were analysed retrogressively, with special reference to the drug therapy immediately before death. Clinically sudden and unexpected death was as common as death which was attributed to asphyxia, but at autopsy (45 patients) mucous bronchial obstruction was established in 37 cases. During the last 24 hours of life, 51 of the patients were given sympathomimetics, 31 of them several sympathomimetics concomitantly and 21 in nebulised form. One of the patients died during an adrenaline injection, and one made liberal use of the orciprenaline aerosol she had brought with her to hospital. The xanthine derivative (glyphylline) was given during the last 24 hours to 50 patients. The glyphylline dose was over 3 g/24 hours in eight cases. The death of seven of them was regarded as clinically sudden and unexpected; at least one patient had manifest symptoms of central nervous system stimulation prior to death. Equally large glyphylline doses, however, were given to the control patients in status asthmaticus who survived. Polypharmacy seems to have been a probable iatrogenic factor influencing the mechanism of death in at least four patients of the total material. Corticosteroids were not administered to four patients who had been managed for the last month prior to hospitalisation with corticosteroids. Other iatrogenic factors influencing the mechanism of death seemed to be technical complications of respirator treatment in two cases and the possibility that respirator therapy was delayed.