Virginia Layng Millonig, PhD, RN, CPNP Associate Professor, Nursing Continuing Education Program

George Mason University, Fairfax, Va

n Asthma Deaths in Childhood: Identification of Patients At Risk and Intervention Strunk, R. C. (1987). The lournal of Allergy and Clinical Immunology L5upplement), 80, Part 2, 472-477.

T he mortality rate among persons with severe asthma can approach 1% to 2%. This rate appears to have been largely una&ected by the recent advances in asthma treatment. Studies of deaths in children with asthma have not included control patients with similarly severe asthma who have survived and thus could not be used to clarify positive as well as neg- ative predictive clinical characteristics. The purposes of this article were to review characteristics indentitied in a previous study that distinguished patients who had a fatal episode from those who did not, to present preliminary data on the use of these characteristics to identify prospectively patients at risk for dying, and to present preliminary data on the value of an intervention strategy designed to decrease the inci- dence of death after discharge.

Of the 57 variables studied, 10 of the 14 variables that distinguished the group of children who died of asthma from the controls indicated that the psycho- logical adaptation of the child or the child’s family was a major component. Three of the physiologic variables that may have been psychologically related were increased asthma in the last week of hospital- ization related to the stress of discharge, use of in- haled beclomethasone because of the importance of self-care techniques in utilizing the drug, and seizures reflective of central nervous system disease. The pres- ence of severe asthma alone apparently did not place patients at increased risk for dying. This study stongly suggests that deaths caused by asthma occur because of the interaction of severe disease with psy- chological problems.

n Short-Term, High-Dose, Systemic Steroids in Children With Asthma: The Effect of the Hypothalamic-Pituitary-Adrenal Axis Dolan, M., Kesarwala, H., Holroyde, J., & Fisher, T. (1987). The lournal of Allergy and Clinical Immunology, 80, 81-87.

hildren with chronic asthma frequently receive “bursts” (less than 7 days) of short-term, high-dose prednisone ( 1 to 2 mg / kg/ day) for immediate ex- acerbations of disease. Certain of these patients may also require inhaled corticosteroids (IC) for control. The effect of these “bursts” on the hypothalamic- pituitary-adrenal axis (HPAA) is unclear. To test the integrity of the HPAA in such patients, this study measured plasma cortisol (F) in response to serial administration of insulin-induced hypoglycemia, fol- lowed by administration of ACTH. This study doc- uments that treatment of children affected by asthma with short-term, high-dose, systemic corticosteroid “bursts” alone (range three to four per year) does not appear to compromise the HPAA. Likewise, as a group, the addition of such “bursts” to the treat- ment regimen of patients receiving daily aerosol cor- ticosteroids does not appear to inhibit corticosteroid dynamics. However, the data suggest that within the group treated with “bursts” and daily aerosol, there are persons who exhibit an impaired HPAA. Those subjects receiving either four or more “bursts” per year or IC plus four or more “bursts” had a subnor- mal response to hypoglycemia stress and ACTH, sug- gesting they may be at risk for adrenal insufficiency.

JOURNAL OF PEDIATRIC HEALTH CARE 161