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In Latin-America, with 603 million inhabitants, the average prevalence of asthma is estimated at 17%, but with wide fluctuations, ranging from 5% in some cities (Mexico) to 30% in Costa Rica. The risk of severe exacerbations seems to be higher in Latin America compared with other regions. A majority of patients uses daily quick-relief medication, with the belief that it is the most important treatment because of its rapid onset of action; without treating the underlying inflammation. Overuse of short-acting beta

Ipratropium bromide (IB), a quaternary derivative of atropine has been extensively recommended as the first bronchodilator to be tried in chronic obstructive pulmonary disease (COPD). Despite the large information concerning IB use, a controversy still persists about the lack of non bronchodilator effects (preventive) of inhaled IB. Therefore, the purpose was: to study the effects of IB (80 micrograms) on histamine-induced bronchoconstriction in moderate airway obstruction due to COPD. From outpatient clinic 9 men aged (mean +/- SEM) 57.9 +/- 2.4 yr with smoking history of 54.6 +/- 5.1 pack-yrs and a mean FEV1 = 1.36 +/- 0.08 liters (47.2 +/- 3.8% predicted) were enrolled to participate in this randomized placebo-controlled double blind cross-over study. Each subject attended on 3 occasions (first visit was control day; logPC20 = -0.54 +/- 0.24 mg/ml; geometric mean [MG] = 0.27 mg/ml) for histamine challenge tests using the tidal breathing method after either 4 puffs of IB or placebo aerosol. IB significantly increased baseline FEV1. A correlation between baseline obstruction (FEV1; FEV1/FVC) and bronchodilation with airway hyperreactivity (logPC20) could not be demonstrated. The major finding was that IB attenuated the histamine-induced bronchoconstriction (logPC20 = -0.15 +/- 0.17 mg/ml; GM = 0.70 mg/ml) in comparison with placebo (logPC20 = -0.76 +/- 0.22 mg/ml; GM = 0.17 mg/ml; p = 0.018; doubling doses: IB = 2.02 +/- 0.68 vs placebo = -0.62 +/- 0.79; p = 0.024). The lack of correlation between bronchodilator response to IB and the shift in logPC20 might indicate an intrinsic protective role of IB against histamine. Both IB and fenoterol completely resolved the final fall in FEV1 after ending the histamine challenge test. In conclusion, IB diminished histamine-induced bronchoconstriction in these subjects with moderate COPD.

Accuracy of death certification and registration have been investigated in many countries because death certificates constitute the unavoidable source for studying asthma mortality. The purposes of this study were: 1) to assess the reliability of official registration of asthma death certification and 2) to describe the percentage of asthma deaths occurring outside-hospital in Rosario during 1988. All death certificates from Rosario residents over 5 years old, in which appeared the word asthma or derivatives, were studied. The asthma mortality rates from 1981 to 1989 were obtained from the "Official annual publication". The diagnosis of asthma was written somewhere on 45 certificates; but 30 certificates were interpreted as asthma being the most appropriate diagnosis and could then be coded as the cause of death. These 30 asthma related deaths occurred at the mean age of 59.23 yrs +/- 17.23 (SD), range 12-84 yrs. Twenty-two deaths out of the total of 30 occurred in an out-hospital setting (73%). Among the 30 cases, 8 subjects (aged 63.0 yr +/- 12.38) died in hospital. There was no difference between the age, sex and the death place. Autopsy was performed in only one case of 12 years old. In other 3 cases, asthma was confirmed as the cause of death through the evaluation of case records and the confidential information collected from close acquaintances. The mean asthma mortality rate from 1981 to 88 in Rosario was 5.69 +/- 1.06/10(5), and this value was significantly higher than the death rate calculated by this study (3.46/10(5); p = 0.0005, T test for one sample). The difference probably originated in the false positive certificates often related to procedures in the General Registrar Office. In other words, there was an official overestimation of asthma deaths. This was the first description of the high percentage (73%) of asthma related deaths occurring in the out-hospital setting. Finally, even when death certificates should require a further and exhaustive assessment, asthma mortality rates in Rosario might be regarded as of great concern.

Reported increases in worldwide asthma mortality have prompted the publications of guidelines and consensus statements on the management of airway disease. Overreliance in bronchodilator therapy and lack of anti-inflammatory treatment have been the major findings and the guidelines are aimed at correcting these problems. The Argentinean population appears to have increased prevalence and severity of conditions characterized by chronic airflow limitation and there is no data, to our knowledge, that has analyzed how the treatment of such conditions has been conducted in the past years. Drug sales data in Argentina were surveyed retrospectively to estimate prescriptions dispensed for the treatment of airway disease for the years 1983 to 1990 inclusive. The number of prescriptions of all airway drugs increased significantly (p0.01) in the 8-year period except for oral beta 2-agonists and disodium cromoglycate (DSCG). Prescriptions for these agents were 42.7% and 69% less frequent respectively. Thus, oral beta 2-agonists declined from being the single most frequently prescribed class of drugs (40% of prescriptions) in 1983 to the third most frequently prescribed (22%) in 1990. Concurrently, prescriptions of inhaled beta 2-agonists in all forms rose significantly comprising 27% in 1983 and 46% in 1990 becoming the most commonly prescribed airway therapy. Despite this apparent trend away from oral bronchodilator therapy, theophylline prescriptions comprised a significantly higher percentage of prescriptions in 1990 as compared to 1983 (30% vs 20%).(ABSTRACT TRUNCATED AT 250 WORDS)

We studied 12 fatality-prone patients for 18 months after they had been discharged from the hospital following life-threatening exacerbations of asthma (mean PaCO2 on admission, 97 mm Hg). Our objectives were (1) to evaluate the natural history of their disease during ambulatory care and (2) to investigate whether close follow-up might help to avert further near-fatal events. Only seven of the 12 patients consented to be enrolled in the study, which included monthly scheduled visits to the hospital and monthly telephone calls to record emergency room visits and changes in therapy. By the conclusion of the 18-month follow-up period, two of the noncompliant patients had died during asthmatic attacks. By contrast, all of the seven who had agreed to participate survived; one required intubation and mechanical ventilation, and the other six required occasional unscheduled emergency room visits because of acute exacerbations. Specific precipitants could not be determined, and the most common cause of the acute episodes was likely inadequate steroid therapy. The results suggest that compliance with adequate antiasthmatic therapy and close follow-up may be important in the prevention of near-fatal events.