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Sudden death in asthma in childhood
1Department of Histopathology, Women's and Children's Hospital, North Adelaide, Australia.
Insights
Sudden childhood asthma deaths are rare. This study found that most fatal cases involved children with severe, chronic asthma, often showing growth retardation, suggesting underlying long-term disease.
Area of Science:
- Pediatric Pulmonology
- Pathology
- Epidemiology
Background:
- Childhood asthma mortality is infrequent, with most fatalities occurring in hospitalized severe cases.
- Sudden, unexpected asthma deaths can occur even in children with seemingly mild disease.
- Understanding the clinicopathological features of fatal childhood asthma is crucial for risk assessment.
Purpose of the Study:
- To investigate the clinicopathological characteristics of children who died suddenly from asthma.
- To identify potential markers for identifying children at risk of sudden asthma death.
- To analyze the association between disease severity, growth parameters, and fatal outcomes in childhood asthma.
Main Methods:
- Retrospective review of 11 cases of sudden childhood asthma deaths from Adelaide Children's Hospital (30-year period).
- Analysis of patient demographics, medical history, clinical presentation, and pathological findings.
- Assessment of growth parameters (height/weight percentile) in relation to asthma severity and outcome.
Main Results:
- Eleven children (aged 3y 10m to 15y 2m) experienced sudden asthma deaths, often outside a hospital setting.
- Viral respiratory infections were common co-findings.
- The majority of cases had severe, chronic asthma requiring prolonged treatment or hospitalization; 73% exhibited growth retardation (<3rd percentile).
Conclusions:
- Sudden, unexpected asthma deaths in children, in this series, predominantly occurred in those with significant chronic disease and growth retardation.
- Growth parameters may serve as a valuable morphological marker for identifying children with long-standing, severe asthma at risk of sudden death.
- While rare, fatal asthma outcomes in children necessitate careful evaluation of disease chronicity and potential indicators of severity.
Abstract:
Death from asthma in childhood is rare, occurring in approximately 1 in 10,000 affected children. While most deaths occur in hospitalised children with severe asthma, it has been reported that sudden and unexpected death may occur in children with only mild disease. In this study the clinicopathological features of 11 cases of sudden death taken from the files of the Adelaide Children's Hospital over a 30-year period are reported. Children were aged between 3 years 10 months and 15 years 2 months (average = 9 years 9 months), with a male to female ratio of 5:6. Deaths occurred either at home, in an ambulance or within minutes of arriving in the Emergency Department. Viral respiratory tract infections were common associated findings. While one child was considered to have only mild disease, most children had long histories of asthma and had required prolonged medication or hospitalisation. The demonstration of growth retardation (i.e. height or weight < 3rd percentile) in 73% of cases is also supportive of long-standing severe asthma being present. Thus, in this series, sudden and unexpected death occurred only in children with significant chronic disease. In formulating the diagnosis of sudden death due to asthma in children, delaying growth parameters may, therefore, be an additional useful morphological marker indicating an at-risk child.