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Letter to the Editor
Severe Asthma Exacerbation in an Intermediate Respiratory Care Unit: Fact or Controversy?
Agudización grave de asma en una unidad de cuidados respiratorios intermedios: ¿realidad o controversia?
Javier Navarro Estevaa,
Corresponding author
jnesteva7@hotmail.com

Corresponding author.
, Antonio M. Esquinas Rodríguezb
a Servicio de Neumología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
b Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The development of respiratory intermediate care units &#40;RICUs&#41; has allowed for better care of patients with acute respiratory failure &#40;ARF&#41; of diverse etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> RICUs are beneficial for patients requiring noninvasive ventilation &#40;NIV&#41;&#46; In the case of severe asthma exacerbations &#40;SAE&#41;&#44; the use of NIV remains controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We read with interest the original study by N&#250;&#241;ez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> analyzing the progress of patients with SAE at an RICU&#46; This important contribution highlights the importance of these units&#46; However&#44; in our opinion&#44; there are some aspects of this study that need to be clarified&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A&#46; In the selection of patients&#44; the date of diagnosis&#44; reversibility of bronchial obstruction&#44; family history&#44; and other features supporting diagnosis are unknown&#46; Among SAE patients admitted to RICU&#44; 37&#37; were active smokers or former smokers&#46; Furthermore&#44; of the ten patients receiving NIV&#44; five were obese and three had kyphoscoliosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This gives rise to the following questions&#58; How many patients had asthma&#63; How many had COPD and not asthma&#63; NIV can be effective&#44; even in patients with COPD and pneumonia &#40;the most frequent finding in RICU patients&#41;&#46; This leads us to wonder whether the patients with kyphoscoliosis and obesity had chronic hypoventilation and whether they could have benefited from NIV&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">B&#46; Regarding the definition of SAE&#44; according to the GINA guidelines&#44; patients with severe asthma flare-up can have a peak flow of &#60;60&#37; of the known or theoretical maximum value&#44; or else &#60;100<span class="elsevierStyleHsp" style=""></span>l&#47;min and&#47;or PaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mmHg&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The average peak flow in RICU patients is substantially greater&#44; so airflow limitation might not be the most influential factor in the blood-gas deterioration&#46; The physical examination parameters suggested by the GINA guidelines &#8211; alertness&#44; use of accessory muscles&#44; respiratory and heart rate&#44; etc&#46; &#8211; have not been reported&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A description of the authors&#8217; recommendations on the criteria for RICU admission would be interesting&#46; Might SAE patients benefit from RICU monitoring&#44; whether they receive NIV or not&#63; We believe that if the previous recommendations are met&#44; the answer is yes&#44; and in this way prompt attention can be guaranteed&#44; if necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In any case&#44; this study does not allow conclusions to be drawn on the effect of NIV in patients with SAE&#44; although we accept that this is not its purpose&#46; Studies of NIV in SAE have been carried out in emergency departments&#46; The use of NIV has been associated with an improvement in lung function and respiratory mechanics&#44; but no changes have been observed in hospitalization or intubation rates&#46; These objectives should be included in future studies&#44; and appropriate selection criteria and methodology &#8211; mode and ventilation parameters&#44; interface type&#44; hours of ventilation&#44; aerosol methodology&#44; etc&#46; &#8211; should be employed&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to economic aspects&#44; we agree that RICUs are cost-effective&#44; but&#44; again&#44; the methodology of this study limits conclusions&#46;</p></span>"
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ISSN: 15792129
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