喘息死の臨床的観察
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概要
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In the current 15 years, the author experienced 58 patients who died of bronchial asthma (or which 27 were subjected to mortem examination) in the 1 st Department of Internal Medicine of School of Medicine, Showa University.<BR>The overall mortality was 1.5%. The asthmatic deaths were more frequent in males and senile people; 45 cases were older than 40, while 13 were younger.<BR>The mortality due to asthma in the patients who were older than 40 years of age was 3.54%, while it was 0.52% in younger ones.<BR>The mortality due to asthma among the patients whose onset were older than 40 years was 6.83% and it was 1.48% in the patients with younger years of onset.<BR>The asthmatic deaths were shared appoximately half and half by the patients with extrinsic type and intrinsic one.<BR>In view of the fact, however, the number of patients with extrinsic type was much greater than that of intrinsic type, it may be chaimed that the death which asthma is more attributable to intrinsic factors than to the extrinsic ones.<BR>As the direct cause of death, suffocation was detected in 52%.<BR>To these patients with unhappy outcome, it was learned that moderated to large amout of steroid had been administered and evident adrenal atrophy was detected in 18 out of 27 autopsied.<BR>Based on the statistics published by the Ministry of Health and Welfare on the causes of deaths, it was learned that the deaths with asthma have so far been in a decreasing trend in parallel with the popularization of steroids, and also that transient increase of it was almost unexceptionally recognized in the years of rampant prevalence of influenza.<BR>Deaths with asthma showed decreasing trends in most classes of age, but the aeg between 5 and 14 (particulary 10 to 14) was found to be increasingly vulnerable to this disease in current years.<BR>Concerned to the causes of this trend, the author speculated the overuse of pressurized aerosols containing sympathometics, considering the same relation between the grow and down tendency of the mortality of younger asthmatics and the consumed dose of pressuried aerosols, as in United Kingdom.<BR>In view of the above-mentioned studies, the author think that steroids may be claimed to be rather contributory than detrimental to treatment of asthma, if their indication are correctly selected, based on the principle that the steroid should not be used if the symptoms appear hopefully curable by mean of other ronline remedies.
- 学校法人 昭和大学・昭和医学会の論文