In the decade of the 1980s, physicians have significantly changed their approach to both their understanding and treatment of asthma. It is not clear if this is related to the increasing rates of morbidity and mortality worldwide with asthma or if it has simply been a function of a better understanding of the pathophysiologic events associated with this disease. Until recently, asthma was primarily thought of as a disease in which the airways had an obstructive process which caused the individuals to have wheezing and shortness of breath. This oversimplified concept has been expanded dramatically, and it is now recognized that inflammation leading to increased bronchial reactivity is the basis for which airways react and become obstructed. The role of inflammation in asthma has been so emphasized that one leading investigator has recently described asthma as “chronic desquamative eosinophilic bronchitis” (1). This terminology takes the asthmatic one step further in understanding the pathophysiologic relationship between airways inflammation and airways reactivity. Secondary bronchospasm and obstruction occur and that this inflammation may be a chronic process.

Severe sepsis, manifested by organ system dysfunction and/or shock, is the leading cause of death in patients in critical care units and is among the leading causes of death in the United States. New molecular biology techniques have allowed for a better understanding of the events that occur at the cellular and subcellular levels and produce this clinical syndrome. These same techniques have, for the first time, added treatment options aimed at blocking these interactions which, if unimpeded, may lead to an over-production of mediators that are toxic to the patient. The challenges remaining include the need for improvement in the early diagnosis of sepsis, clearer definitions of clinical stages of illness, and the need for careful clinical trials of the many potential therapeutic combinations.

From Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL. Address requests for reprints to: Dr. Roger C. Bone, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, 600 S. Paulina, Suite 202, Chicago, IL 60612.

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A new term, the systemic inflammatory response syndrome (SIRS), has been coined to describe a pathophysiological state that occurs secondary to infectious and noninfectious states such as burns and trauma. When SIRS is secondary to infection, it is called sepsis. In SIRS the host response produces the inflammatory reaction to the inciting agent.

Iberti, Thomas J.; Bone, Roger C.; Balk, Robert; Fein, Alan; Perl, Trish M.; Wenzel, Richard P. Author Information

To formulate recommendations for the development of intensive care unit (ICU) admission policies.Literature review of published reports over the period 1966 to 1991 pertaining to admission criteria for intensive care or coronary care units (CCUs).Studies identifying patients least likely to benefit from ICU or CCU admission were analyzed. Patient populations of interest included adults (> or = 18 years of age) with medical conditions possibly requiring intensive care; trauma patients were excluded.Of 970 articles identified as being pertinent to intensive care, only two case-control studies used the direct method of measuring the effect of ICU intervention on mortality. No studies were found that compared outcomes of low-risk patients treated in a CCU vs those treated in alternative hospital locations, and none identified patients with a very high probability of a bad outcome.The use of decision-making models for ICU and CCU admissions must be tested in prospective, randomized clinical trials. Critical care units and ICUs should be studied separately. Existing studies of early discharge from CCUs need to be summarized and evaluated. The triaging of ICU patients to alternative hospital locations needs to be evaluated, as do existing predictive models for early triage decision-making.