Risk factors for childhood asthma deaths from the UK  Eastern Region Confidential Enquiry 2001-2006.
BACKGROUND
Confidential enquiries into asthma deaths can identify inadequacies in medical management and factors which contribute to patients' death.


OBJECTIVE
To identify risk factors for paediatric asthma deaths over a 6-year period.


METHODS
Observational case-series study of paediatric asthma deaths between 2001-2006 in the UK Eastern Region. Hospital, primary care and post-mortem data were obtained for every child (≤17 yrs) with asthma recorded on the death certificate, and a detailed questionnaire was completed. Information was obtained on asthma severity, medications, hospital admissions, GP and hospital follow-up, adherence, psychosocial / behavioural factors, allergies, details of the terminal attack and precipitating factors.


RESULTS
20 children (10 male; 8-17 yrs; median: 11.5 yrs) died of asthma between 2001-2006. 9/20 had mild to moderate asthma (BTS/ SIGN criteria), 10/20 had severe asthma and 1 child was not known to have asthma. 13/20 were clinically atopic. Only 3 had undergone allergy assessment. 10/20 died between June and August. 12/20 children had adverse psychosocial and behavioural factors. 7/20 children were on non-combination long-acting β2-agonist (LABA) treatment without inhaled corticosteroids (ICS).


CONCLUSIONS
Almost half the deaths occurred in children with mild/moderate asthma. We recommend that allergic factors and seasonal allergy should be identified early, non-combination LABAs avoided, and speculate that overuse of short-acting β2-agonists (SABAs) may indicate non-adherence with ICS. Asthma deaths in children can be avoided if risk factors are identified early.
Department of Allergy, Cambridge University Hospitals NHS Trust, Cambridge, UK.
Katherine
K
Anagnostou
Brian
B
Harrison
Richard
R
Iles
Shuaib
S
Nasser
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000145:classification / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006967:Hypersensitivity / Q000150:complications*; D008297:Male; D055118:Medication Adherence; D011320:Primary Health Care; D015272:Pulmonary Medicine; D012307:Risk Factors; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
D018927:Anti-Asthmatic Agents