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A yearlong randomized, controlled Asthma Intervention Research (AIR) trial examined the efficacy and safety of bronchial thermoplasty as a treatment for moderate or severe persistent asthma. The findings suggested that bronchial thermoplasty in subjects with moderate or severe asthma results in an improvement in asthma control.

Byline: A. Rabbat (1), J. P. Laaban (1), A. Boussairi (2), J. Rochemaure (1) Keywords: Key words Acute severe asthma; Blood lactate; Bronchodilator therapy Abstract: Objective: To evaluate arterial lactate levels during treatment of acute severe asthma (ASA) and the prognostic value of arterial hyperlactatemia in ASA. Design: Prospective study. Setting: A respiratory intensive care unit (ICU) of a university hospital. Patients: 29 consecutive patients admitted to the ICU for ASA not intubated on admission and with a peak expiratory flow (PEF) &lt 150 l/min or an arterial carbondioxide tension (PaCO.sub.2) &gt 40 mm Hg. All patients received standardized treatment during the first 24 h including i. v. and nebulized salbutamol, i. v. theophylline, and dexamethasone. Measurements and results: Arterial lactate levels were serially measured by an enzymatic method during the first 24 h following admission. On admission, the mean arterial lactate level was 3.1 +- 0.38 mmol/l (range 1.1--10.4) 17 patients (59 %) had arterial hyperlactatemia with a lactate level &gt 2 mmol/l. No difference was found in lactate levels between patients with progressively worsening asthma and those with an acute onset of severe asthma. No correlation was found between arterial lactate levels on admission, on the one hand, and respiratory rate (RR), heart rate, PEF, pH, PaCO.sub.2, arterial oxygen tension, potassium, phosphorus, creatine kinase, or transaminase values on admission, on the other hand. All patients developed an important but transient increase in arterial lactate levels during treatment, with a peak at 7.72 +- 0.46 mmol/l and a mean elevation of 4.62 +- 0.45 mmol/l (range 0.4--12.1), from the initial admission value contrasting with a significant clinical improvement assessed by RR, PEF, and arterial blood gas parameters. Conclusion: This study suggests that, in ASA, arterial hyperlactatemia is frequently present on admission to the ICU. Delayed hyperlactatemia is a constant finding during treatment of ASA. Initial or delayed hyperlactatemia seems of no prognostic value because none of the patients required mechanical ventilation. The effects of therapy for acute asthma on lactate metabolism still need to be studied. Author Affiliation: (1) Service de Pneumologie et Reanimation Medicale, Hotel-Dieu de Paris, 1 place du Parvis Notre-Dame, F-75181 Paris Cedex 04, France Fax: + 33 (1) 42 34 81 99, FR (2) Service de Biochimie, Hotel-Dieu de Paris, 1, place du Parvis Notre-Dame, F-75181 Paris Cedex 04, France, FR Article note: Received: 29 July 1997 Accepted: 26 January 1998

Patients with long-term asthma appear to have survival rates similar to the expected rate of survival based on vital statistics tables. A study of 2499 asthma patients in the Rochester, Minnesota area who were diagnosed in the years 1964 to 1983 revealed that of the 140 patients who died, only 4% died as a result of asthma. None of these patients were children. The combination of asthma and another lung disease, particularly chronic obstructive pulmonary disease, was associated with a lower than expected rate of survival. Most patients with this combination were over the age of 35. Asthma patients living in the community rather than in institutions may experience good health and expected survival. Population-based studies of asthma patients may provide explanations for variations of rates of asthma-related deaths in different communities.