Asthma deaths in children--a continuing problem.

Mellis, Craig; Phelan, P. D.

doi:10.1136/thx.32.1.29

Cited by 92 publications

(13 citation statements)

References 19 publications

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“…There is a need for corticosteroid treatment in acute asthmatic attacks in children recently on either oral14 or inhaled16 steroids. The inadequate corticosteroid dosage found in the acute attack in this study has been observed previously in studies on adults' and children.2 14 There was no evidence of any increase in steroids or reduction in sedative prescriptions similar to that found in the London inpatient survey9 over the 20 years of review.…”

Section: Discussionsupporting

confidence: 77%

Thirty deaths from asthma.

Carswell¹

1985

Archives of Disease in Childhood

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Surveys in London and Newcastle3 4 suggest that childhood asthma is being underdiagnosed and undertreated. Despite many leading articles and reviews 9 and the increased admission rates of asthmatic children to hospital, there is little evidence of a decline in paediatric mortality. The present survey was carried out to ascertain the circumstances of the deaths and to decide if these were avoidable. Methods

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Section: Discussionsupporting

confidence: 77%

Thirty deaths from asthma.

Carswell¹

1985

Archives of Disease in Childhood

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“…Although there is little evidence on this point, it seems probable that the depth of inhalation is a factor of great importance, and that the efficacy of BDA depends on its reaching the smaller airways. Therefore, it seems prudent to advise all patients to take an inhalation of a bronchodilator aerosol a few minutes before they inhale BDA Mellis & Phelan (1977) reported three deaths in children under very similar circumstances. Undoubtedly, BDA is often prescribed without the patient being given clear instructions about its purpose.…”

Section: Discussionmentioning

confidence: 99%

Experience of the use of beclomethasone dipropionate aerosol in general practice.

Gregg¹

1977

Brit J Clinical Pharma

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1. The findings of an open trial of beclomethasone dipropionate aerosol (BDA), carried out in 1972 in the author's general practice, are discussed in the light of subsequent, more extensive experience of its use of BDA. 2. An important reason why BDA may be unsuccessful in controlling asthma, and may give rise to various problems, is that patients are often given an inadequate explanation of the purpose and proper use of this treatment.

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“…The range of factors associated with increased risk of death include poor socioeconomic circumstances [15], delay in diagnosis and under-treatment of disease, both long-term [8] and in the final acute event [7]. Such factors as poor perception of airflow limitation and inadequate use of oral corticosteroid are also highlighted [3,7,13,14]. However, no studies have been able to satisfactorily compare and contrast the factors in the patients who have died with those of individuals with severe asthma who have not died.…”

Section: Discussionmentioning

confidence: 99%

A childhood asthma death in a clinical trial: potential indicators of risk

Warner¹,

Nikolaizik²,

Besley³

et al. 1998

Eur Respir J

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A 9 yr old girl with a history of eczema and asthma was admitted to our specialist asthma service and recruited into a trial designed to investigate systemic as well as therapeutic benefits of inhaled corticosteroids. Eight months after referral the patient died from an acute asthma attack. This childhood asthma death during an inhaled steroid trial has facilitated identification of risk factors. Despite good clinical response to inhaled corticosteroids, the patient was distinguishable from the other patients by: increased variability of the morning and evening peak flow rates; increased reactivity, though not sensitivity, to histamine; and an unprecedented rise in serum soluble interleukin-2 receptor levels immediately after commencing inhaled steroids. The immunological basis for corticosteroid resistance and immunohistochemical studies on postmortem specimens from asthma deaths suggest that T-cell activation markers may be indicators of the fatality prone asthmatic.

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Asthma deaths in children--a continuing problem.

Cited by 92 publications

References 19 publications

Thirty deaths from asthma.

Thirty deaths from asthma.

Experience of the use of beclomethasone dipropionate aerosol in general practice.

A childhood asthma death in a clinical trial: potential indicators of risk

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