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December 8, 1975

Status Asthmaticus-Reply

Author Affiliations

Washington University School of Medicine St Louis

JAMA. 1975;234(10):1016-1017. doi:10.1001/jama.1975.03260230016005

In Reply.—  The letter of Drs Rothstein and Shapiro regarding our article, "Status Asthmaticus" (231:1277, 1975), makes several important points on which we wish to comment.First, we would emphasize that our remarks were directed mainly at the adult asthmatic patient. The distinction between the adult and small child is important because, as Drs Rothstein and Shapiro imply, children may be more responsive to sympathomimetic agents. Also, significant metabolic acidosis accompanying status asthmaticus is not uncommon in children, whereas it is unusual in adults.We agree that vigorous hydration and large doses of antiinflammatory corticosteroids may result in fluid retention and that caution is warranted, especially in the patient with underlying cardiac disease. Indeed, attention to daily weights and to fluid intake and output are crucial for the avoidance of overhydration and pulmonary edema. In suggesting a dosage of steroids, we were not recommending hydrocortisone necessarily as the steroid of