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Asthmatic Deaths in Children

J. J. Robbins, MD
JAMA. 1966;197(2):151. doi:10.1001/jama.1966.03110020139052.
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To the Editor:—  There is an often-quoted opinion concerning the treatment of bronchial asthma, repeated by Kessler and Geller-Bernstein (196: 458, 1966), that asthmatic deaths in children have risen in recent years because of wide-spread use of steroids. Although, as these Israeli physicians state, hypoadrenalism is a distinct possibility, the evidence is against this explanation for deaths in asthma.

  1. The death-rate increase antedates the steroid era. Mustachi in an epidemiological study in 1962 states that there were 6,000 deaths from asthma in 1956 in the United States.

  2. In not a single postmortem study of asthma deaths has significant adrenal atrophy been demonstrated. Certainly none of adrenal hemorrhage has come to my attention.

  3. In my own experience with over 1,500 asthma patients in the last ten years, although ketosteroid levels have generally been low in steroid-treated patients, no mortality has been encountered.

The consistent finding at post-mortem, as in Richards' cases,


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