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April 28, 1993

Ventilatory Management of Respiratory Failure in Asthma

Author Affiliations

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.

JAMA. 1993;269(16):2128-2131. doi:10.1001/jama.1993.03500160098040

CASE PRESENTATION  The patient whom I wish to discuss this morning is unable to be present because she is dead. What I want to talk about is why that happened, and how it could possibly have been prevented. She was a 60-year-old nonsmoking woman who had asthma since the age of 16 years. She had been hospitalized seven times for asthma since 1980, but had never been intubated. She had been given prednisone intermittently, but never for more than 3 months at a time. There was no history of cardiac disease.Fourteen days prior to admission, she complained of dyspnea, went to the emergency department (ED), and was given nebulized albuterol, a theophylline drip, and a bolus of methylprednisolone. She was discharged on a 10-day tapering course of prednisone. She came back to the ED 2 days before admission because the dyspnea had recurred. She was given the same medications,