Characteristics of near-fatal asthma in childhood.
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)
D000293:Adolescent; D001249:Asthma / Q000150:complications / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D002648:Child; D003717:Denial, Psychological; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care; D012131:Respiratory Insufficiency / Q000209:etiology; D012803:Sick Role; D013021:South Australia / Q000453:epidemiology; D013997:Time Factors