Near-fatal asthma in children and young adults: an international eDelphi Study

Guidelines and evidence identify that children and young people (CYP) who die from asthma frequently have a severe preceding attack. There is no agreed name or case definition for the most severe form of asthma attack. We aimed to resolve this using a structured literature, guideline and multimedia review to inform an international electronic Delphi (eDelphi) process.

A scoping literature, international guideline and anecdotal evidence (multimedia reporting) review provided items and potential names for round 1 of 3 for an eDelphi. Likert scoring of 1-5, with ≥70% combined score of 4 and 5 provided consensus. Free text enabled additional items and names to be offered. Participants were consultants providing acute asthma care in paediatric and adult respiratory, emergency or critical care medicine from 25 countries. In the final round, participants were provided with a stem definition with two further add-on options.

Fifty-two studies were identified by scoping review (from 586 studies) with 27 international guidelines providing 41 items and 4 potential names to round 1. 104 participants completed all 3 rounds, offering an additional 10 items and 3 names for round 2. Near-fatal asthma (NFA) was the preferred name in round 3 (66.7%). The 22 items reaching round 2 consensus were placed within stem text where a definition was agreed (83/104, 79.8%).

This study provides a preferred name and consensus definition of NFA in CYP. This research can enable better characterisation and delivery of care to this vulnerable population.