Showing papers by "Frank E. Speizer published in 1968"

Observations on recent increase in mortality from asthma.

Abstract: The mortality attributed to asthma has increased annually in England and Wales from 1960 to 1965. The increase is more pronounced at ages 5 to 34 years than at older ages and is most pronounced at ages 10 to 14 years. In this last age group the mortality increased nearly eight times in seven years, and in 1966 asthma accounted for 7% of all deaths. No comparable increase has been observed in any other country, but smaller increases at ages 10 to 19 years have been observed in Australasia, Japan, western Europe, and the United States. There is no evidence to suggest that there has been any change in diagnostic habits, certification of deaths, or methods of classification which could account for the increase in Great Britain, and it is concluded that the increase is real. General practitioners' records provide no evidence of an increase in prevalence and it seems probable that there has been an increase in case fatality. No environmental hazards are known which could have increased the severity of the disease, and the possibility has to be considered that the increase may be due to new methods of treatment. Corticosteroids have been used increasingly since 1952, and in Great Britain the use of pressurized aerosols containing sympathomimetics has increased rapidly since 1960.

Investigation into use of drugs preceding death from asthma.

Abstract: Copies of death certificates were provided by the Registrar General for all deaths attributed to asthma in persons aged 5 to 34 years which were registered in England and Wales in the last quarter of 1966 and the first quarter of 1967. Information was obtained from the relevant general practitioners about 177 of the 184 subjects, and necropsy data were obtained for 113 of the 124 cases in which a post-mortem examination was known to have been made. Ninety-eight per cent. of the subjects for whom evidence was obtained were known to have been suffering from asthma, and signs of severe asthma (overdistended lungs and small bronchi plugged with mucus) were found in 91% of necropsies (57% of all deaths). Evidence that death might have been due to any other pathological condition was rare. Death was sudden and unexpected in 81% of the subjects (137 out of 171), and 59% of all deaths were referred to coroners. In 39% of cases (67 out of 171) the practitioner had not regarded the patient as suffering from severe asthma in his terminal episode. Corticosteroids and sympathomimetic preparations were the only drugs to have been used by a large proportion of patients. Two-thirds of the patients had received corticosteroids before the terminal episode, but detailed information about their use provided no suggestion that excess use could have been responsible for any large proportion of the deaths. Eighty-four per cent. of the patients were known to have used pressurized aerosol bronchodilators, and several instances of their use in excess were described. Routine inquiries about their use in the hours immediately preceding death were not made, and further evidence is required before their effect can be assessed adequately.

A century of asthma deaths in young people.

Abstract: BDICTIL 245 We hope that the building is an effective expression of our wish to provide for both group and individual activities; for openness of communication with due allowance for privacy; and for therapeutic, educational, and recreational activities (which are so closely interrelated). We have attempted to plan and equip the various rooms so that they can be used for a variety of functions-for example, the hall has gymnastic and recreational equipment and a demountable stage, as well as facilities for films and lectures. The living areas, general-purpose room (girls), kitchen, and occupational therapy room will offer scope for domestic/house-hold activities. The classrooms, quiet room, occupational therapy room, and general-purpose room (boys) have equipment for formal schoolroom work, technical and commercial studies, hobbies, craft work, and art. There is within the unit no central or focal point, no room or area which is unequivocally the one part of the building around which other activities revolve, or in which the main activities take place. This is not owing to a failure to recognize the need for such a focal point. It was considered that having regard to the provisional treatment policy which had been evolved, no room or area should be given such special emphasis or prominence as to imply or suggest that it should be the most important part of the building. Just as it was considered that most of the rooms should be multipurpose, allowing flexibility of use and function by both patients and staff, so it was considered that both patients and staff, in their working and living together, should be able to choose, depending on the needs at the particular time, which room(s) or area(s) to use for different purposes. There is no central observation point, no central nurses station. Clearly, the absence of such a room reduces the range of observation which can be undertaken by any one nurse, thus placing a considerable responsibility on staff who are required to be aware of patients' movements within the building. But it was decided to accept the risks inherent in this rather than oreate a more institutional type of situation in which dormitories or sitting-rooms would be under observation by staff. Experience may prove us mistaken, but it was our opinion that to have a focal point and central observation station for nursing staff might have value in terms of economy of staff, but would not be appropriate …