Asthma mortality in the Danish child population: risk factors and causes of asthma death

Abstract

Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108 cases of asthma death in 1-19-year-olds in Denmark, 1973-1994. Copies of death certificates, hospital records, information from general practitioners, and autopsy records were obtained. The information was assessed with particular reference to: features and duration of asthma before death; severity of asthma; time and place of death; long-term and ongoing medical treatment; quality of medical care; circumstances of final illness; and medical treatment during the final episode of asthma. Age groups of 1-4 years, 5-14 years, and 15-19 years were analyzed separately and in aggregate. Death occurred predominantly in the 15-19-year age group. Generally, significantly more patients died in the summer. These patients were more atopic, had fewer asthma symptoms, and did not have regular asthma consultations. Nearly all patients had early-onset asthma. The 1-4-year age group was characterized by severe asthma. Major risk factors (all age groups) were: gradual deterioration during the last month; length of final attack (>3 hr); and delay in seeking medical help during the final attack. None of the children died during their first attack. Nonadherence was most frequent among the 15-19-year-olds. All asthmatic children and young adults should regularly receive medical care and assessment, even if they suffer only a few symptoms. This study underlines the need for ongoing education of the patient's family, the patient, and doctors on long-term management and management of acute attacks. Copies of clearly written individual plans for periods with increasing symptoms should be supplied to the patient/family and, where appropriate, to their general practitioners. The object of these measures is that the patient and parents/family learn to recognize the signs of deterioration and to act on them.

Risk Factors for Pediatric Intensive Care Admission in Children With Acute Asthma

“…These characteristics have been reported by others as well. 3,4,6,9 An important observation was that non-sanitized homes and (active or passive) smoking were not uncommon, in spite of the fact that patients, parents, and physicians may be assumed to be aware that these constitute risk factors for worsening of asthma and for SAA.…”

“…[3][4][5][6][7][8][9][10][11] All these variables were extracted from the medical records. Data from the period prior to the PICU admission were considered as the baseline values for variables that could potentially change over time (eg, smoking, pets, hay fever).…”

“…2,3 Case series have suggested that certain characteristics, such as having divorced parents, lower socioeconomic class, poor adherence to treatment, and pre-existent severe asthma, may enhance the risk of SAA. [3][4][5][6][7][8][9][10][11] SEE THE RELATED EDITORIAL ON PAGE 1526 Most of these studies stem from outside Europe, and were published before 2005. Recent European studies on this topic are lacking.…”

Risk factors for childhood asthma deaths from the UK Eastern Region Confidential Enquiry 2001–2006

“…[3][4][5] A number of previous studies from different parts of the world have also reported on risk factors contributing to asthma deaths. [6][7][8][9][10][11][12][13] The aim of this observational study was to identify risk factors contributing to asthma deaths in children during a 6-year study period (2001)(2002)(2003)(2004)(2005)(2006). The Eastern Region population is approximately 5.5 million, 22% of whom (1,276,000) are children below the age of 18 years.…”

Efeito do exercício físico na inflamação pulmonar e na resposta imunológica sistêmica em pacientes com asma persistente moderada ou grave

“…Alguns autores argumentam que a exacerbação é a varável mais importante, porque constitui o maior risco para os pacientes, são um motivo de ansiedade para os pacientes e suas famílias, resultam em maior pressão sobre os profissionais da saúde, além de gerar o maior custo para o sistema de saúde (Lane et al, 2006). As exacerbações são reconhecidas como uma manifestação clínica comum em pacientes com asma grave e são conhecidos por aumentar o risco de mortalidade por asma (Jorgensen et al, 2003). Surpreendentemente, apenas durante os últimos 10 anos as exacerbações têm sido usadas como uma variável primária na investigação sobre eficácia de drogas no tratamento da asma (Pauwels et al, 1997;Reddel et al, 2009 do exercício regular para reduzir as a exacerbações em pacientes asmáticos.…”