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[Sudden unexpected death and near death among children with asthma]
K C Lødrup1, A Svindland, O K Refvem
1Allergologisk poliklinikk, Barneavdelingen Familie- og Barnklinikken, Ullevål sykehus, Oslo.
Insights
Sudden asthma deaths in children highlight risks of viral infections and excessive bronchodilator use. Understanding severe asthma attacks is crucial for preventing fatalities.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Asthma exacerbations can lead to life-threatening events in children.
- Viral infections are known triggers for pediatric asthma attacks.
- The role of bronchodilator overuse in severe asthma is a concern.
Observation:
- Two children died suddenly from asthma, and one experienced a life-threatening attack over four winter months.
- A toddler with asthma died suddenly post-adenovirus infection, despite being asymptomatic hours earlier.
- A child with severe asthma died from respiratory arrest after three days of nebulized salbutamol use.
Findings:
- A 16-year-old experienced respiratory arrest after using at least 400 doses of salbutamol via inhaler in two days.
- The cases suggest varied mechanisms contributing to severe asthma attacks in children.
- Sudden death and respiratory arrest occurred in children with different asthma severities and triggers.
Implications:
- Highlights the critical need for vigilant asthma management in children, especially post-viral infections.
- Underscores potential dangers of excessive short-acting beta-agonist (SABA) use in pediatric asthma.
- Emphasizes the importance of understanding diverse pathophysiological pathways in severe pediatric asthma attacks.
Abstract:
During four winter months 1989-90, two children died suddenly from asthma, and one suffered a life threatening attack. A 20 months old boy with moderately severe asthma, just recovered from an adenovirus infection, was symptom free at a routine consultation less than 12 hours before death. He died suddenly after a spell of coughing. A six year old girl with severe but well controlled asthma received unknown quantities of inhaled nebulized salbutamol during a three day exacerbation. She died at home due to respiratory arrest. A 16 year old boy who attended the clinic sporadically had a severe uncontrolled attack of asthma. He inhaled at least 400 doses of salbutamol via a metered dose inhaler during the two days prior to a sudden respiratory arrest. He was successfully resuscitated. This paper addresses possible mechanisms underlying different types of severe attacks of asthma.