Robin E D
Stanford University Medical Center, CA 94305.
Chest. 1988 Mar;93(3):614-8. doi: 10.1378/chest.93.3.614.
There is now incontrovertible evidence that there is a progressive and strikingly increased mortality from bronchial asthma in the US. The increase is more dramatic in the older age groups, but younger age groups are not spared. The exact cause or causes of this increased mortality are not known, and it is even possible (although not likely) that the increase is artifactual. This increased death rate is in sharp contrast to the general medical perception that major advances in the management of bronchial asthma have occurred. Perhaps they have, but if so, more patients are dying during this period of advances than were dying before. The most prudent course would be to assume that the excess deaths are iatrogenic in origin and to act accordingly. Even if this assumption is flawed, acting on it would improve the management of patients with bronchial asthma. If it is true that the major purpose of risk-benefit analysis is to improve patient outcome rather than merely analyze risk-benefit balance, then a series of proposals can be generated to grapple with this problem in bronchial asthma.
目前有确凿证据表明，美国支气管哮喘的死亡率呈上升趋势，且显著增加。这种增加在老年人群体中更为显著，但年轻人群体也未能幸免。这种死亡率增加的确切原因尚不清楚，甚至有可能（尽管可能性不大）这种增加是人为造成的。这一死亡率的上升与医学上普遍认为支气管哮喘治疗取得重大进展的观念形成了鲜明对比。也许确实取得了进展，但即便如此，在此进展期间死亡的患者比以前更多。最谨慎的做法是假定额外死亡源于医源性因素并据此采取行动。即便这一假设存在缺陷，依此行事也会改善支气管哮喘患者的治疗。如果风险效益分析的主要目的确实是改善患者预后而非仅仅分析风险效益平衡，那么就可以提出一系列建议来应对支气管哮喘中的这一问题。
