Relation of acute bacterial (suppurative sinusitis) and viral (pseumonitis) infections to status asthmaticus.

Abstract

While a good many people still adhere to the long-cherished notion that the asthmatic lives to a ripe old age, the literature suggests that the frequency of death from asthma has been increasing 1ately.l Asthma is no longer considered as one disease that bears the “certificate of long life.” Dworetzky6 mentioned the factors contributing to death as: allergic sensitivity, infections, psychosomatic and other factors still undetermined. In another article, he cited air pollution and inappropriate management, due to errors either of omission or commission, as causes for the increase in m~rtality.~ Infection, broadly termed respiratory, usually refers to bronchial infections and pneumonitis. These are the common findings of many authors in the literature. However, while we do not dispute its importance, we have not found its incidence to be as high as acute infections of the nose and paranasal sinuses. In the course of routine ENT clearance for all hospitalized or office-treated asthmatic patients, it was observed that a high percentage of the severely ill asthmatics had superimposed acutely severe bacterial infections of the nose and paranasal sinuses, particularly the anterior group of sinuses. Most of these patients were promptly relieved after good drainage or pumping of the sinuses. Eisenj states, on the basis of the evidence for infectious allergy in bronchial asthma, that “there is the rare patient whose asthma improves dramatically after drainage of a purulent sinus or removal of infected tonsils and adenoids.” The purpose of this study is to establish the definite role of acute suppurative sinusitis and viral pneumonitis as important precipitating and/or aggravating factors in cases of status asthmaticus.