Releases Saturday 14 July 2001
No 7304 Volume 323
Please remember to credit the BMJ as source when publicising
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(1) OXYGEN TREATMENT FOR SVERE ASTHMA
COULD SAVE LIVES
(2) H
Pylori TEST NOT ALWAYS USEFUL FOR
DIAGNOSING
ULCERS
(3) UNIQUE
NEW SCORING SYSTEM CAN PREDICT
RISK OF DEATH
FROM CARDIOVASCULAR
DISEASE
(1) OXYGEN TREATMENT
FOR SVERE ASTHMA
COULD SAVE LIVES
(Oxygen treatment for acute severe
asthma)
http://bmj.com/cgi/content/full/323/7304/98
Asthmatic patients are still dying during
severe attacks, yet
making oxygen available in every general
practice to treat
patients with a life threatening asthma
attack could save lives,
concludes a study in this week's BMJ.
The authors urge the
British Thoracic Society to review this
issue when it updates
its asthma guidelines.
A research team in London reviewed 11 studies
of acute
severe asthma in both children and adults.
Despite some
limitations, these studies show that hypoxaemia
(an inadequate
supply of oxygen to the tissues) is an
important cause of death
during a severe asthma attack. Some studies
also suggest that
treatment with air during severe attacks
may worsen
hypoxaemia.
The British Thoracic Society's guidelines
advise oxygen as a
first line treatment in hospital for all
patients with acute severe
asthma. In general practice however, the
guidelines imply that
general practitioners should be prepared
to treat acute asthma
of all severities but do not advise the
use of oxygen for
children or insist on its use in adults.
This may be because
many general practices do not keep an
oxygen cylinder.
Oxygen should be the first treatment for
acute severe asthma
wherever the patient happens to be, say
the authors. Given
that most asthma deaths occur in the community,
oxygen
should be available in every general practice.
Patients with
severe disease could also be provided
with oxygen cylinders
for emergency use at home, they conclude.
Contact:
Mark Rolans, Consultant, Birmingham Heartlands
Hospital,
Birmingham, UK
(2) H Pylori TEST
NOT ALWAYS USEFUL FOR
DIAGNOSING ULCERS
(Testing for Helicobacter pylori
in
dyspeptic patients suspected of
peptic ulcer disease in primary
care: cross sectional study)
http://bmj.com/cgi/content/full/323/7304/71
Routine testing for H pylori infection
in patients consulting their
general practitioner with indigestion
(dyspepsia) does not aid
the diagnosis of peptic ulcers, concludes
a study from the
Netherlands in this week's BMJ.
Testing is useful only in patients at high
risk of peptic ulcer
disease, and these patients can be identified
by asking three
simple questions during the consultation,
report the authors.
Between June 1996 and January 2000, general
practitioners in
Utrecht recorded the age, sex, medical
history and smoking
behaviour of 565 patients suffering with
dyspeptic symptoms
of at least two weeks' duration. All patients
were subsequently
tested for H pylori infection.
In all patients, smoking, pain on an empty
stomach, and a
history of peptic ulcer were independent
predictors of peptic
ulcer disease. Adding the H pylori test
did not provide any
additional diagnostic information. However,
in a group of
patients at high risk, identified by means
of a simple scoring
system, the predicted presence of peptic
ulcer increased from
16% to 26% after a positive H pylori test.
Despite some study limitations, the authors
conclude that
adding testing for H pylori infection
to history taking might be
useful only in patients at high risk of
having peptic ulcer
disease. It would avoid invasive examinations
in some patients
and lead to more accurate treatment of
peptic ulcer disease in
most patients.
Contact:
Catherine F Weijnen, Clinical Research
Fellow, University
Medical Center Utrecht, Netherlands
Email: c.f.weijnen{at}med.uu.nl
(3) UNIQUE NEW
SCORING SYSTEM CAN PREDICT
RISK OF DEATH FROM CARDIOVASCULAR
DISEASE
(A score for predicting risk of death
from cardiovascular
disease in adults with raised blood
pressure, based on
individual patient data from randomised
controlled trials)
http://bmj.com/cgi/content/full/323/7304/75
A unique new scoring system for assessing
a patient's risk of
death from cardiovascular disease is revealed
in this week's
BMJ. The score will help physicians determine
a patient's
need for drugs to reduce blood pressure
(antihypertensive
drugs) and other strategies for improving
cardiovascular
health.
The score is based on information from
eight large trials of
antihypertensive drugs, involving over
47,000 men and women
across Europe and North America. It uses
11 risk factors,
including age, sex, systolic blood pressure
and total
cholesterol levels, smoking, and diabetes,
to quantify an adult's
risk of death from cardiovascular heart
disease. Points are
added for each factor according to its
association with risk
and patients can be classified simply
as high or low risk
compared with others of the same age and
sex.
Age is a particularly strong risk factor
? a woman aged 60-64
has 23 extra points compared with a woman
aged 35-39. Sex
is also important, with men having 12
extra points. Smoking
attributed more in women and younger age
groups. In women,
cholesterol levels mattered less than
in men, whereas diabetes
had more of an effect.
As the score is based on a large group
of patients in controlled
trials of antihypertensive drugs, it has
wide applicability in
general practices and hypertension clinics,
providing a simple
means of quantifying a patient's risk
of cardiovascular disease
based on what should be routinely available
information,
conclude the authors.
Contact:
Francois Gueyffier, Physician, Service
de
Pharmacologie Clinique, Lyon, France
FOR ACCREDITED JOURNALISTS
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
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Advancement of Science
(http://www.eurekalert.org)
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