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Survey of asthma deaths in the Northern region, 1970-85
H J Fletcher1, S A Ibrahim, N Speight
1Department of Child Health, University of Newcastle upon Tyne.
Insights
Preventable factors significantly contributed to childhood asthma deaths. Improving asthma management and education for families on recognizing severe symptoms and crisis plans is crucial for reducing fatalities.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Public Health
Background:
- Childhood asthma remains a significant public health concern.
- Asthma mortality in children, though rare, necessitates detailed investigation to identify preventable factors.
- Understanding the circumstances surrounding pediatric asthma deaths is vital for improving clinical care and patient outcomes.
Purpose of the Study:
- To conduct a detailed investigation into the factors contributing to asthma deaths in children aged 1 to 16 years.
- To identify potentially preventable management issues in fatal pediatric asthma cases.
- To provide recommendations for reducing childhood asthma mortality.
Main Methods:
- Retrospective case review of 35 childhood asthma deaths.
- Analysis of patient history, including previous hospital care and severity of asthma.
- Evaluation of management strategies during the final asthma attack and overall treatment.
Main Results:
- Eighty-three percent of cases (29/35) had a history of severe asthma, with 17 experiencing life-threatening attacks previously.
- Potentially preventable management factors were identified in 80% of cases (28/35).
- Suboptimal management of the final attack, due to delayed medical attention or inadequate response, was a major factor in 57% of deaths (20/35).
Conclusions:
- A significant proportion of childhood asthma deaths involve preventable factors, including chronic undertreatment and suboptimal management of acute attacks.
- Enhanced education for families on recognizing severe asthma symptoms and implementing crisis plans is essential.
- Improved hospital protocols for managing severe pediatric asthma attacks, including free access and timely intervention, are critical for reducing mortality.
Abstract:
Thirty five asthma deaths in children aged 1 to 16 years were investigated in detail. Twenty four of these children had previously been under hospital consultant care and there were seven inpatient deaths. Twenty nine cases (83%) had a history of severe asthma, 17 of whom had previously experienced a life threatening attack. The fatal outcome, however, could not have been predicted in six children (17%) with preceding mild asthma. Potentially preventable factors in management were found in 28 cases (80%). While 18 (51%) had been chronically undertreated, the major factor in 20 deaths (57%) was suboptimal management of the final attack owing to delay in seeking medical attention, inadequate medical response, or both. Only two children had received systemic corticosteroid in appropriate amounts during the final illness. If mortality is to be reduced, families of asthmatic children must be educated to recognise severe symptoms and be given an appropriate 'crisis plan'. Hospitals should permit free access and have a clear protocol for the management of children with severe asthmatic attacks.