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Circumstances surrounding the deaths of children due to asthma. A case-control study
1Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver.
Insights
Certain psychological and treatment factors in adolescents with asthma may increase their risk of fatal attacks. These include family disturbance, despair, and decreased steroid use before a severe asthma episode.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Child Psychology
Background:
- Acute asthma attacks pose a significant risk to children.
- Understanding factors contributing to asthma mortality is crucial for prevention.
- Previous studies have not fully elucidated the specific characteristics differentiating fatal from non-fatal severe asthma attacks in adolescents.
Purpose of the Study:
- To compare the characteristics of fatal severe asthma attacks with life-threatening but non-fatal attacks in children.
- To identify patient, family, and treatment factors associated with asthma-related mortality in pediatric patients.
Main Methods:
- A case-control study comparing 12 deceased asthmatic children with 12 survivors of life-threatening asthma attacks.
- Data collection included structured interviews with families and physicians, and review of medical records.
- Analysis focused on asthma management and patient characteristics in the 6 months prior to the attack and during the acute episode.
Main Results:
- Adolescents who died from asthma attacks showed increased respiratory failure, decreased steroid use, family disturbance, and expressed hopelessness in the 6 months preceding the event.
- Fatal attacks were more likely to begin during sleep, while vomiting was less frequent.
- Suboptimal parental treatment, primarily due to delays, was noted in both groups but more frequently in those who died.
Conclusions:
- Specific patient and family characteristics, alongside certain treatment patterns, are associated with an increased risk of asthma-related death in adolescents.
- Potential inherent differences in the mechanisms of acute asthma exacerbations may exist between children who die and those who survive.
Abstract:
Features of the courses in 12 children who died of an acute attack of asthma were compared with those in 12 children of comparable age and sex who had a life-threatening attack of asthma but survived. Information obtained by structured interviews with the families and physicians and from the medical records was used to characterize (1) the patient, family, severity, and treatment of asthma primarily in the 6 months before the attack and (2) medical circumstances and patient characteristics present on the day of and/or during the acute episode. Patients in the study (mean age, 14.1 years) and controls (mean age, 13.8 years) were in early to late adolescence, had similar long-term medication use histories and an overall rating of the severity of asthma. For the analysis of the information concerning the 6 months before the attacks, the study patients had a greater frequency of respiratory failure requiring intubation, a decrease in steroid use in the month before the attack, history of family disturbance, abnormal reaction to separation or loss, and expressed hopelessness and despair. For the period more immediately surrounding the acute attack, study patients more often had attacks starting during sleep, but less frequently experienced vomiting during the course of the attacks. Treatment of the attack by the parents was poor (primarily because of delays) in 7 of the 12 children who died, but was also a factor in 6 of the 12 controls. Our data suggest that certain characteristics of asthmatic children may place them at greater risk for death due to their asthma. In addition, we postulate that there may be inherent differences in the mechanisms of the acute attacks between the children who died and those who survived.