A nationwide survey in Germany on fatal asthma and near-fatal asthma in children: different entities?

Abstract

In adults fatal and near-fatal asthma have similar clinical characteristics. Therefore, near-fatal asthma in adults can be used as a model for fatal asthma. A nationwide study on fatal and near-fatal asthma in children <16 yrs was performed in order to assess whether, as in adults, near-fatal asthma can be used as a model for fatal asthma.From 1996 to 1998, all paediatric hospitals and paediatric pulmonologists in Germany were asked to report cases of fatal asthma and near-fatal asthma to a central survey unit (Erhebungseinheit fu È r seltene pa Èdiatrische Erkrankungen in Deutschland (ESPED)) on a monthly basis. All reports were followed by detailed questionnaires.Sixteen fatal and 45 near-fatal asthma cases were analysed. Fatal asthma patients were older than near-fatal asthma patients. Respiratory tract infections were frequently reported only in near-fatal asthma (47 versus 0%). The proportion of cases with rapid-type onset (duration of symptoms #1 h) was higher in fatal asthma (53 versus 14%). Long-term regular treatment with short acting b 2 -agonists was common in both groups, but the use of concomitant inhaled corticosteroids was significantly lower in fatal asthma cases. A high proportion of poor compliance was observed in both groups.As fatal and near-fatal asthma differ significantly in important clinical aspects, analysis of near-fatal asthma might be of limited value in elucidating the causes of fatal asthma in children. Eur Respir J 2000; 16: 845±849.

Investigating Asthma Deaths among Children and Young Adults: Michigan Asthma Mortality Review

“…Although there is an overlap between the risk factors for fatal asthma and near-fatal asthma, there are differences. 18,19 One major difference previously reported is in steroid use, which is more frequent in near-fatal than in fatal asthma cases; another is in the duration of asthma, which is shorter in near-fatal than in fatal asthma cases. A program to investigate near-fatal asthma cases would generally not capture individuals at risk of fatal asthma.…”

Duration of Mechanical Ventilation in Life-Threatening Pediatric Asthma: Description of an Acute Asphyxial Subgroup

“…12,13 Near-fatal asthma episodes are known to occur in children. [14][15][16][17] There seems to be a subset of children with near-fatal episodes whose presentation and clinical course may be comparable to those seen in AAA in adults. 18 We hypothesized that children who have rapidly progressive asthma and require early mechanical ventilation will have more rapid improvements in gas exchange and require shorter durations of mechanical ventilation than children who have asthma and slowly progress to respiratory failure.…”

Socioeconomic conditions and type 1 diabetes in childhood in North Rhine–Westphalia, Germany

“…In 1996, the catchment area of the register was extended to the total of NRW, and since 2002 new cases up to the age of 34 years have been registered. The primary data source for incident cases of diabetes is a well-established active hospital-based surveillance system for rare childhood diseases in Germany that is operated on the basis of monthly report cards and is known as Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland (ESPED, German paediatric surveillance system) [31]. Amongst others, ESPED also serves as data source for a nationwide register on type 1 diabetes covering children under 5 years of age [32].…”