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Clinical Investigations in Critical CareHeroin Insufflation as a Trigger for Patients With Life-Threatening Asthma*
Section snippets
Materials and Methods
Cook County Hospital is a public hospital that serves metropolitan Chicago. Approximately 11,000 adult patients per year are treated in the emergency department (ED) for asthma exacerbation, and roughly 4% require hospital admission for > 23 h. Patients requiring ICU admission represent roughly 10% of total asthma hospital admissions; the majority of these are admitted directly from the ED. Patients admitted to the ICU for asthma have either impending or actual respiratory failure, or a severe
Study 1: Case Series
In the first 6 months of 1999, there were 26 admissions for asthma in patients aged 16 to 50 years admitted to the ICU (Table 1). Three patients had two ICU admissions; thus, there were a total of 23 patients. All patients were African American, except one patient who was white. The mean age of the patients was 35 years. Childhood onset of disease was reported by 45%. Fifteen of 22 patients (68.2%) reported using an inhaled corticosteroid. Of the 16 patients for whom the source of asthma care
Discussion
We have observed that heroin insufflation is a common trigger for asthma symptoms among patients requiring ICU admission for asthma in an urban public hospital. This phenomenon has occurred sporadically since March 1997 and may have been operative prior to that date. In the first 6 months of 1999, the majority of persons (13 of 23 patients) admitted with severe asthma to the ICU gave a clear history that heroin insufflation precipitated asthma exacerbations generally, and in some cases, clearly
ACKNOWLEDGMENT
We thank Drs. David Gummin and Paul Bonucci for assistance in data collection, Drs. Henri Frischer and Jay Shannon for review of the manuscript, and Dr. Lawrence Ouellet and the staff of the Community Outreach Intervention Projects for information provided on drug use practices in Chicago.
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