Survey of asthma deaths in the Northern region, 1970-1985

Article Abstract:

Asthma is a lung disorder characterized by breathing difficulties, wheezing, and coughing. Although there have been many improvements in the care and treatment of children with asthma, some deaths still occur. Poor medical treatment is responsible for 80 percent of childhood asthma deaths, most of which could have been prevented. To see if there are factors that can predict or prevent death from asthma, 35 asthma deaths of children in Northern England aged 1 to 16 were investigated. Twenty-four children had a recent asthma attack requiring hospitalization prior to death. Seven children died in the hospital. Severe asthma was diagnosed in 29 cases (83 percent), 17 of whom already experienced a life-threatening attack. The fatal episode could not have been predicted in six children (17 percent), who were diagnosed with mild asthma. Flaws in the treatment of the fatal episode were noted in 28 cases (80 percent). Eighteen children were chronically undertreated (51 percent). In 20 cases (57 percent), the main cause of death was mismanagement of the final fatal attack. Treatment errors included a delay in seeking medical attention, inadequate medical response, or a combination of the two. Seven children were not given adequate access to bronchodilators. Only two children were given adequate corticosteroid treatment prior to death. It is clear from these results that many asthma deaths can be prevented if appropriate measures are followed. Parents and children must receive extensive patient education regarding asthma control and self-management. Families should have access to bronchodilators that deliver high doses of medication to nonbreathing children. Inhaled corticosteroids should be offered to children who are not responding to other treatments. Parents ought to know all physical danger signs such as breathlessness, inability to talk, paleness or blue skin color, poor chest movements, or increased lethargy and exhaustion. Hospitals must develop aggressive treatment protocols for children entering the emergency room with an asthma attack. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, United Kingdom, Patient outcomes, Mortality, Great Britain

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Hydration in severe acute asthma

Article Abstract:

Children with acute asthma attacks are frequently given intravenous fluid replacement, as they are thought to become dehydrated during such attacks. The extent to which such dehydration occurs has not been rigorously studied, and replacement with both very large and with limited volumes of fluid have been advocated as appropriate. To better understand the appropriateness of fluid replacement during acute asthma, the extent of dehydration occurring in 20 children, aged 5 to 12, suffering asthmatic attacks was evaluated. The children's weights on admission were 97.9 percent of their stable reference weights on average, and this was a significant reduction. There was a slight increase in the proportion of blood volume occupied by blood cells, indicating that less of the blood volume was composed of fluid. The small weight changes, combined with other observations, suggest that most of the children were only mildly dehydrated. The extent of dehydration correlated weakly with the duration of the asthma attack. The only medical sign correlating with dehydration was a decrease in blood pH (increase in acidity), but this effect was not large enough to be of use in medical practice. The rate of recovery from the asthma attacks did not correlate with the degree of dehydration. The study suggests that additional fluids above normal requirements are unnecessary in acute asthma attacks, and that intravenous fluids may be safely given at a rate of 50 milliliters per kilogram body weight per 24 hours. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Dehydration (Physiology)

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Long term outcome of ventilated asthmatics

Article Abstract:

Intermittent positive pressure ventilation (IPPV) is a mechanical method for assisting inhalation. A device is used to administer air or oxygen to inflate the lungs under positive pressure. Exhalation is usually passive. This method was introduced in the 1950s and was used routinely to treat respiratory failure in the 1960s. Previous studies showed that IPPV treatment of children with asthma was associated with a good outcome and low rates of death and complications. The prior characteristics of 31 children with asthma who required IPPV, the clinical course, and outcomes of these episodes were assessed. In addition, the subsequent outcomes of children who survived the IPPV episodes were evaluated over a 25-year period. At one children's hospital in England, 47 episodes of artificial ventilation occurred between 1971 and 1989, with no decline in the average number of episodes of 2.5 per year. Eight children died during IPPV, and three of 23 children who survived IPPV episodes subsequently died from asthma. Of 17 children assessed for a year following IPPV, 16 had persistent symptoms of asthma, and half had daily asthma symptoms. Ten patients underwent testing of lung function. A fourth patient died from asthma during follow-up. These findings show that children who survive IPPV treatment continue to be at high risk for disease and death. However, each year, IPPV treatment continues to be a requirement for a small number of children with asthma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Positive pressure respiration

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