Preventable factors and death certification in death due to asthma

A 2 yr District-wide study was carried out to assess whether there were preventable factors in the management of patients dying from asthma, and also to assess the accuracy of death certification of asthma. Eighteen deaths occurred in which asthma was the certified cause of death. In 10, asthma was the actual cause of death. Due to inaccuracies of death certification, death was due to other causes in seven cases. In the remaining case it was not possible to differentiate between asthma and chronic obstructive airways disease. Among the 10 deaths from asthma the condition was considered to be mild in three. In three, death occurred too rapidly for help to have been available. Preventable factors were present in four cases. In three, either the patient, the doctor or both failed to appreciate the severity of the condition and the need for urgent help or hospitalization. The fourth patient had failed to seek any medical care. Many lives might be saved if patients and doctors treated severe breathlessness due to asthma with the same sense of urgency that chest pain suspicious of myocardial infarction is treated. Education is needed to improve both the clinical and post mortem accuracy of death certification. Both this and the management of asthma should be the subject of ongoing local audits.