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  • Title: Slow-onset asthma deaths have more eosinophils and health care utilization than rapid-onset deaths.
    Author: Hyzy RC, Travis WD, Hanna E, Lyon-Callo S, Flaherty KR, Rosenman KD.
    Journal: Respir Med; 2008 Dec; 102(12):1819-26. PubMed ID: 18692379.
    Abstract:
    RATIONALE: Patients with fatal asthma have been hypothesized as representing two distinct subgroups according to the onset of symptoms prior to death. OBJECTIVES: To determine if these two groups may be reliably identified and determine if they differ clinically and pathologically. METHODS: Patients with autopsies, 2-34 years of age, dying from asthma were classified slow-onset (Type 1) or rapid-onset (Type 2). The consistency of classification by two independent observers was determined. Clinical and pathologic data was compared between groups. MAIN RESULTS: Among 37 subjects there were 21 Type 1 and 16 Type 2 mortalities. Inter-observer agreement was good; kappa 0.63 (95% CI 0.38, 0.87). Subjects did not differ by age, race, sex, presence of obesity, insurance status, or use of corticosteroids. Type 1 mortalities were hospitalized more (2.5+1.3 versus 0.1+0.1; p=0.048) and made more emergency room visits (10.5+4.9 versus 0.8+0.2; p=0.023) in the year prior to death than Type 2 mortalities. At autopsy, bronchial eosinophils (p<0.025) and bronchiolar basement membrane thickening (p<0.05) were more predominant in Type 1 mortalities compared with Type 2. Airway wall neutrophils were uncommon in both groups. CONCLUSION: Good inter-observer agreement exists in classifying patients dying from asthma according to whether the onset of symptoms was slow or rapid in onset. Slow-onset patients had a predominance of eosinophils and basement membrane thickening and higher health care utilization. These differences support the validity of classifying asthma mortalities into these distinct subgroups.
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