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Biomedical subjects

E Zapata

Publications and source records attributed to E Zapata.

12 recordsLinked to original sources
PubMed1983

Current therapeutic practice in the management of acute severe asthma.

In a prospective study we have documented the treatment administered to patients before and during attacks of acute severe asthma, including cases managed at home by the general practitioner and those treated in hospital. In the course of 1 year, 261 consecutive episodes were studied. Five patients required artificial ventilation but there were no fatalities. In 28 patients (11.8%) no regular maintenance therapy was being taken before the index attack, and in 72 (30.3%) no regular treatment with a beta 2-adrenergic bronchodilator. Childhood asthmatics were receiving less maintenance therapy than adults, with the exception of cromoglycate. An increased dose of a beta 2-adrenergic bronchodilator was taken prior to medical consultation in 64.7% as the attack developed, but an increased dose of oral steroids in only 19.3%. The general practitioners gave intravenous steroids in 53 cases (61.6%), but rarely combined this with a bronchodilator. However, when a combination of a bronchodilator and intravenous steroids was given, there was a significant reduction in the need for hospital admission. In hospital the majority of patients received intravenous steroids as well as a nebulized beta 2-adrenergic bronchodilator and an intravenous xanthine bronchodilator, but one-third were not given oxygen. Sedatives were rarely used. Differing treatment patterns emerged when contrasting childhood with adult episodes, whether managed inside or outside hospital. Comparisons are made between the treatment observed in practice and that currently recommended for optimal treatment, and the implications are discussed.

Acute Disease↗
PubMed1983

Acute severe asthma: factors that influence hospital referral by the general practitioner and self-referral by the patient.

We describe a prospective study of 261 consecutive episodes of acute severe asthma occurring in 232 patients in 1 year. Sixty-seven episodes were treated at home by a selected group of 34 general practitioners, 148 episodes were treated in hospital following referral from general practitioners and 46 episodes were treated in hospital after self-referral, not having been seen by a general practitioner. All patients recovered fully. Comparisons between these groups of patients showed that those selected for hospital admission had higher pulse rates, lower peak expiratory flow rates and more severe grades of attack than those treated at home. Children were more likely to be admitted to hospital, as were patients living near to hospital, or those who were already receiving hospital outpatient supervision. There were self-referrals in all age groups. Several factors which influence the decision on admission, including the speed of onset and severity of the episode, justify some shift of the primary care role from the general practitioner to the hospital. If self-referral is to be encouraged there is a need for agreement on the types of patient and the nature of the attack that are best suited to this type of management.

Acute Disease↗
PubMed1982

The speed of onset and severity of acute severe asthma.

The speed of onset of attacks of acute severe asthma was prospectively studied in a total of 261 consecutive episodes. 82% of these episodes involved patients with 'extrinsic' asthma and 28% involved children. The speed of onset of an attack was rapid (defined as less than 24 hours) in 46% of episodes and was less than one hour in 13%. Rapid-onset attacks occurred more frequently in younger patients and were no more or less severe than attacks of slower evolution. Comparison of different measures of severity in our patients showed statistically significant but low correlations. Objective measures seemed no better than simple clinical assessment with the Jones index. We discuss the significance of these correlations and the place of emergency admission services for attacks of acute severe asthma of rapid speed of onset.

Acute Disease↗
PubMed1980

Isocyanate-induced asthma in a car factory.

In a car factory employing 203 women machinists making seat covers more women complained of respiratory symptoms after the introduction of a new seat cover fabric, cropped nylon backed with flame-bonded polyurethane foam (CNPF). 68 women working in the trim shop were studied on the first day back at work after a week's holiday and then at the end of a working week; the incidence of wheezing and/or shortness of breath was greater than expected but there was no difference between peak flow rates. A second study of 192 of the 203 women working in the trim shop confirmed this recent increase in incidence of asthmatic symptoms and showed that significantly more machinists who had worked with this new fabric had a reduced peak flow rate than machinists who had not. Asthma developed in one subject when she was working in the factory sewing CNPF, when she was handling this fabric in the challenge cabinet in the laboratory, and on challenge with toluene di-isocyanate in the laboratory. Airways resistance increased in 3 other workers after exposure to CNPF in the laboratory. Low concentrations (between 0.0003 to 0.003 ppm) of toluene di-isocyanate were found in the air around this fabric. 4 of 9 women with symptoms had IgE antibodies to toluene di-isocyanate.

Asthma↗