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Characteristics of near-fatal asthma in childhood
A J Martin1, D A Campbell, P A Gluyas
1Department of Pulmonary Medicine, Women's and Children's Hospital, North Adelaide, South Australia.
Insights
This study on near-fatal childhood asthma attacks in South Australia found that most children had severe asthma, experienced significant symptoms, and often delayed seeking medical care. Psychosocial factors and high denial scores were also prevalent in these critical pediatric asthma cases.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Public Health
Background:
- Childhood asthma remains a significant health concern, with near-fatal exacerbations requiring intensive medical intervention.
- Understanding the factors contributing to severe asthma attacks in children is crucial for improving patient outcomes and prevention strategies.
Purpose of the Study:
- To investigate the clinical characteristics and contributing factors of near-fatal asthma attacks in children under 15 years.
- To identify potential areas for intervention in the management of severe pediatric asthma.
Main Methods:
- A survey of 30 children experiencing near-fatal asthma attacks in South Australia over a 3-year period (May 1988-June 1991).
- Data collection involved standardized interviews and questionnaires with patients/parents and medical practitioners.
- Case data were reviewed by an expert panel using predetermined criteria.
Main Results:
- The majority of patients (83%) had severe asthma; 20% were under 7 years old, and 53% were 12-15 years old.
- Common issues included frequent nighttime awakenings (50%), significant exercise limitation (79%), and a history of hospital admissions (70%).
- High denial scores (80%) and significant psychosocial factors (73%) were noted, with 63% delaying medical care.
Conclusions:
- Near-fatal asthma attacks in children are often associated with severe disease, delayed medical care, and significant psychosocial factors.
- There is a need for improved asthma education, crisis planning, and potentially earlier intervention, especially in high-risk pediatric populations.
- The underutilization of peak-flow meters in children over 7 highlights a gap in routine asthma management and monitoring.
Abstract:
As part of the South Australian asthma mortality survey, we examined 30 cases of near-fatal asthma attacks in children under 15 years of age who were seen over a 3-year period from May 1988 to June 1991. Subjects presented with asthma and either respiratory arrest, PaCO2 above 50 mm Hg, and/or an altered state of consciousness or inability to speak on presentation at a metropolitan Adelaide teaching hospital. A standardized interview and questionnaire was completed with subjects/parents and medical practitioners. Data were reviewed by the assessment panel which made collective judgments based on predetermined criteria. Seventeen patients (57%) were male, 20% were less than 7 years of age, and the majority (53%) were aged between 12 and 15 years. The majority (83%) had severe asthma and only one case (3.3%) had mild asthma. Half of the subjects were waking every night due to asthma and 79% had significant exercise limitation. A quarter of the subjects had a previous ICU admission and 70% had a hospital admission in the last 12 months. Primary care was carried out by a general practitioner in 57% of cases, and 70% of subjects had a crisis plan. Only 46% of those older than 7 years of age had ever used a peak-flow meter. Eighty percent of subjects or their families had high denial scores, and in 73% of cases psychosocial factors were considered to be significant. Eighty percent of cases experienced acute progressive respiratory distress, and 63% of cases delayed seeking medical care.(ABSTRACT TRUNCATED AT 250 WORDS)