Deaths from asthma in childhood: can they be predicted?

We have used a case-controlled study to clarify positive, as well as negative, clinical characteristics of children who die with asthma. Variables discriminating between 21 patients who died from asthma and 21 asthmatic control cases matched for age, sex, and severity of illness were: 1) seizures with asthma attacks (p less than 0.01); 2) large reductions in prednisone dose (p less than 0.01); 3) disregard of wheezing (p less than 0.06); 4) increased asthma in the week before discharge (p less than 0.05); 5) poor self-care (p less than 0.01); 6) parent/staff conflict (p less than 0.01); 7) depressive symptoms (p less than 0.05); 8) use of inhaled beclomethasone (p less than 0.05); 9) patient/staff conflict (p less than 0.01); 10) patient/parent conflict (p less than 0.05); 11) manipulative use of asthma (p less than 0.01); 12) emotional disturbance (p less than 0.01); 13) history of reaction to separation or loss (p less than 0.01); and 14) family dysfunction (p less than 0.05). Most of the clinical characteristics previously thought to place patients at greater risk for a fatal asthmatic attack were equally frequent in the children who died and the control cases. This study indicates that psychological risk factors were prominent in severely asthmatic children who subsequently died of asthma.