Several years ago I received a message to call a New York City policeman about the discovery of the body of a sixty-six-year-old woman who had been under my care for asthma. The patrolman had been called by neighbors to enter the patient's apartment since she was not answering her door or phone. A number of people had seen her enter her building in some distress. She had used her bronchodilator spray in the lobby of her building and had not been seen or heard from since. When the policeman and neighbors entered the apartment they found my patient in a chair, still in her overcoat, clutching her bronchodilator spray. The patient had apparently died soon after entering her apartment.
This patient was a delightful woman who edited a foreign policy journal. Office visits were often forums for discussion of a number of topics and she enjoyed debating different points of view. Unfortunately, she had severe asthma that required frequent courses of corticosteroid as well as a long list of other medications. I had seen her about a month before she died, noted significant wheezing, and prescribed oral corticosteroids. She was afraid of further steroid use and resistent." I can just use my asthma spray a little more and i shall be alright ." Further discussion revealed she had stopped or reduced a number of her medicines on her own (" I do'nt think I need them").
Fatal asthma is always tragic since it can usually be prevented. I often wonder what the outcome would have been if this patient had taken her prescribed medication. A number of physicians have said "no one should die of asthma." Unfortunately, these deaths still occur.
Support Systems
Adult Asthma
In managing bronchial asthma, it helps the patient to have a support system; this is particularly helpful for patients with moderate or severe asthma who may need emergency care. For adults this should include a "care partner" who is aware of the patient's illness, physician's name and phone number, and pharmacy number and who has access to a list of the patient's medications as well as the written instructions that the patient has received from the physician. The patient as well as the care partner should know the location of the nearest emergency room in case of a severe attack. Patients should choose carefully their care partners in terms of proximity and accessibility.
A support group may also be helpful for patients with bronchial asthma. Patients with asthma may have experienced severe attacks and have fears concerning future episodes and dependency on medication. In addition, patients may fear to exercise and undertake social activities. Many patients may have been misinformed as to the nature of their illness ("it's all in your head") and have been objects of ridicule. Patients should look to their local lung association or medical society if their physicians are not familiar with a specific program. These support groups should be managed by a physician who is a specialist in respiratory diseases. As noted, the primary source of information should be the patient's Physician, but a support group may further the patient's knowledge and ability to cope with this disease. Patients who have difficult problems in these areas may benefit from professional counseling. The primary physician should be the source of a referral.
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