The treatment of patients with severe asthma and chronic bronchitis

Abstract

IT is considered that asthmatics are peculiarly liable to develop chronic bronchitis, and the experience of a recent community survey in Newcastle (1957) gave very strong confirmatory evidence of this. O f 464 confirmed bronchifics, 43 were found to be asthmatical, whereas of 485 confirmed non-bronchitics selected by a random method, only 5 were asthmatics. The use of such a term as asthmatic bronchitis has, however, been avoided as inaccurate and likely to prove misleading. All the patients were severely disabled, losing at least three months' work each year, and in fact many had not worked for a number of years because of their disability. A number who were working for a considerable part of the year were able to do so only because they had managed to obtain very light work where they could take their own time. All were admitted in a deliberate at tempt to improve their health. Emergency cases, such as status asthmaticus and acute infective episodes, were excluded. The series is otherwise unselected and consecutive. Diagnosis depended upon the clinical signs and upon the history. The clinical signs insisted on were poor air entry and expiratory obstruction, associated with an obvious bronchial stridor (though other signs were often present). The history has not necessarily been uniform and the cases have, in fact, fallen into three groups. In the first of these groups, a characteristic story of intermittent asthma from childhood became complicated at some point by persistent cough with sputum. Coincidentally continuous wheezing with breathlessness replaced the earlier intermittent asthmatic attacks. Recurrent winter colds on the chest became a further regular complication. In the second group continuous asthma and chronic bronchitis commenced almost simultaneously, although acute asthmatic attacks occurred in addition in some cases. The third group was much the smallest. In these cases, chronic bronchitis had been present for some years before becoming complicated by asthma, continuous with or without acute attacks. In both the second and third groups persistent nasal catarrh was an extremely common associated symptom.