CHEST: Home Asthma Device Linked To Deaths

SALT LAKE CITY, Oct. 25 -- When asthma patients plug in a home nebulizer to dispense bronchodilating medication they may be perilously over their heads, said an investigator here.

The result could be fatal, reported Amit Gupta, M.D., of the University of Michigan at East Lansing at CHEST 2006, the meeting of the American College of Chest Physicians.

Dr. Gupta said that incorrect use of home nebulizers may have contributed to some of the 86 asthma-related deaths in the state from Jan. 1, 2002, to Dec. 31, 2004.

The devices were often not used according to guidelines, Dr. Gupta said, "which may have contributed to poor outcome in some cases."

Specifically, he said, the use of the devices may have contributed to a "false sense of security" that led some patients to be slow to seek medical care in the face on acute exacerbation.

Also, the symptomatic relief given by the devices may have led to over-reliance on bronchodilators, with a consequent poorer chronic control of asthma.

And finally, he said, patients may have been led to under-use of steroids, which is known to lead to poor outcomes.

"The heart breaking thing is this asthma morbidity and mortality is preventable if we properly manage the disease," Dr. Gupta said.

Dr. Gupta and colleagues analyzed death records and conducted interviews with next-of-kin of 38 asthma patients who were between two and 18 years old at the time of death and 48 who were between 18 and 34.

All told, they obtained interviews with 71% of relatives, he said.

The researchers found that:

• Fifty-two patients had a home nebulizer and 30 used it regularly (defined as once a week to six times a day).
• Thirty-eight had a peak flow meter and eight used it daily.
• Twenty-nine had both and eight used both of them regularly.

But a key finding was that among the 30 patients who used the nebulizer regularly, steroid use was inadequate, Dr. Gupta said. Specifically, inhaled corticosteroids were indicated for all 30, prescribed for 67% and used by 37%, he said.

Also, nine patients with nebulizers had written asthma action plans but none used them to monitor their disease. Dr. Gupta said.

The researchers suggested that increased medical supervision is needed, as well as dispensing peak flow meters and written asthma management plans with nebulizers, pharmacy notification to physicians for refills on bronchodilators, and emphasis on home asthma management education.

Because of the reliance on death records and telephone interviews, "the data collected is imprecise," commented Paul Selecky, M.D., of Hoag Memorial Presbyterian Hospital in Newport Beach, Calif., who moderated the session at which Dr. Gupta presented his data.

He added there may well be an association between home nebulizer use and deaths of asthma patients, as Dr. Gupta and colleagues suggested, but it's not necessarily the fault of either devices or the patients.

"Sicker patients use a home nebulizer more often, and sicker patients are more likely to die," he said.