Asthmatic patients are still dying during severe attacks, yet making oxygen available in every general practice to treat patients with a life threatening asthma attack could save lives, concludes a study in this week's BMJ. The authors urge the British Thoracic Society to review this issue when it updates its asthma guidelines.
A research team in London reviewed 11 studies of acute severe asthma in both children and adults. Despite some limitations, these studies show that hypoxaemia (an inadequate supply of oxygen to the tissues) is an important cause of death during a severe asthma attack. Some studies also suggest that treatment with air during severe attacks may worsen hypoxaemia.
The British Thoracic Society's guidelines advise oxygen as a first line treatment in hospital for all patients with acute severe asthma. In general practice however, the guidelines imply that general practitioners should be prepared to treat acute asthma of all severities but do not advise the use of oxygen for children or insist on its use in adults. This may be because many general practices do not keep an oxygen cylinder.
Oxygen should be the first treatment for acute severe asthma wherever the patient happens to be, say the authors. Given that most asthma deaths occur in the community, oxygen should be available in every general practice. Patients with severe disease could also be provided with oxygen cylinders for emergency use at home, they conclude.