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Dr Rubenstein has raised some of the same questions that we have asked ourselves both during the collection of the data for our study and on an ongoing basis. National Jewish Center has had long experience with the care of children and adults with severe asthma. Physicians from all 50 states and several foreign countries refer patients who have not been able to be controlled in their home community despite expert primary care and allergy-pulmonary consultation. The reasons for referral are severe medical illness and the psychosocial problems that accompany severe chronic illness. Therefore, the patients usually represent a small percentage of patients at the most extreme end of the illness spectrum. Patients admitted to the center are cared for by a team consisting of pulmonary-psychiatric nurses, pediatric psychiatrists, psychologists and social workers in consultation with psychiatrists, and rehabilitation specialists. The team is directed either by a full-time,
Strunk RC, Mrazek DA. Reducing Deaths Caused by Bronchial Asthma-Reply. JAMA. 1986;255(9):1140. doi:10.1001/jama.1986.03370090061019