Circumstances surrounding the deaths of children due to asthma

Article Abstract:

Asthma is a hypersensitive reaction in the lungs characterized by wheezing, coughing and excess mucous production. Although most asthma patients can control their symptoms, some patients die, either suddenly or after a prolonged untreated episode. In some cases, deaths from asthma can be avoided. The most common causes of death are poor asthma management and lack of patient cooperation, delayed medical interventions, and inadequate drug use. Some patients and relatives do not recognize the severity of the attack and delay seeking medical help. Other contributing factors are severe anxiety and allergic reactions. To determine factors preceding a severe attack, the course of the disease was described in 12 children who died of asthma and in 12 children who had a severe asthma attack but survived. The children's families were interviewed to ascertain precipitating factors six months before, a day before and during the episodes. The patients who died experienced more breathing complications requiring intubation (the use of a tube in the airway to improve breathing) six months before the attack. They used fewer steroid drug medications in the months preceding the attack. The patients often came from poorly functioning families, had encountered an unusual reaction to separation or loss, and had more feelings of hopelessness and despair. More asthma attacks during sleep, with concomitant decreases in associated vomiting, were reported. Delay in treatment was found in seven out of the 12 children who died and six out of the 12 surviving children. The characteristics preceding the severe asthma attacks differed in the two groups of children. The role of these factors in producing life-threatening episodes needs to be studied. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Patient outcomes, Mortality, Physiological aspects, Asthma, Asthmatics

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Relative carnitine insufficiency in children with type I diabetes mellitus

Article Abstract:

Similarities between type I diabetes mellitus and other congenital metabolic defects have led researchers to look at the levels of carnitine, a chemical produced in the body or obtained through diet, which is necessary for the metabolism of fats. A deficiency in carnitine causes problems in the storage of fats, heart functioning, muscle weakness, failure to thrive, low blood sugar and recurrent infections. In most cases, increasing carnitine in the diet is sufficient therapy. Patients with poor control of their diabetes have increased fat metabolism, which increases their need for carnitine. To assess levels of increase in poorly controlled diabetic children, 54 children with type I diabetes were studied. Carnitine can be found in the body in a free state or bound, as acyl carnitine. Free carnitine was deficient in 13 children, particularly girls. Acyl carnitine was high in 30 children. The abnormal levels of carnitine did not correlate with other factors indicative of poor diabetic control. There was a correlation, however, between urine glucose and ketone, indicators of poor blood sugar metabolism, and the level of acyl carnitine. The role of carnitine in the management of diabetes requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Measurement, Juvenile diabetes, Carnitine, Diabetes in children

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Pulmonary hypertension and asthma in two patients with congenital heart disease

Article Abstract:

Pulmonary hypertension, or abnormally elevated pressure within the blood vessels of the lungs, has not often been associated with asthma. Two cases are described in which the male infants had congenital heart disease, asthma, and pulmonary hypertension. The patients did not have hypoxia (lack of oxygen), acidosis (excess of hydrogen) or polycythemia, an abnormality of the blood often secondary to pulmonary or heart disease. The pulmonary hypertension occurred when there was no evidence of wheezing from asthma. One child developed wheezing during hospitalization after the testing procedures, and the other had an episode of status asthmaticus within a month. Both babies had a family history of asthma. It is not known whether pulmonary hypertension and asthma are associated. More must be learned about the relationship between bronchoconstriction, as occurs in asthma, and the pulmonary vasoconstriction that occurs in pulmonary hypertension. It is suggested that patients with pulmonary hypertension may require more aggressive treatment of their asthma, even if the latter condition is mild. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Congenital heart disease, Congenital heart defects, Pulmonary hypertension

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