Sudden death in asthma

Article Abstract:

Clinical treatment of asthma has improved dramatically, but the possibility of sudden death remains very real. Details about the characteristics of asthmatics who may be at risk are insufficient, hence the life-threatening feature of asthma remains unidentified. Two cases of sudden death from moderately severe but medically controlled asthma are described. Two girls, 14 and 9 years old, who were regularly supervised by an asthma clinic appeared to be tolerant of and stabilized by standard medication, such as inhalers, topical steroids and theophylline; each history documented participation in physical activities at school. Tests on lung function and bronchial activity were performed on the girls 5.5 and 1 months before their deaths, respectively. Consequently, lung function and bronchial activity data were collected on 37 children at least 8 years old who had the same level of severity and were receiving the same medication, for the sake of comparison. Relative to the other children, the two girls who died suddenly had exhibited an increased range of reactivity, lower level of lung function based on the cold air challenge test, and an incomplete normalization after bronchodilator medication. These two reports are insufficient for a solid explanation of sudden death in adolescent asthma, but they do indicate that careful, repeated evaluation of the parameters that define lung function may be a useful way to identify those patients who may be susceptible to sudden death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Patient outcomes, Mortality, Physiological aspects, Asthma

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Delay in diagnosis of childhood asthma and its influence on respiratory consultation rates

Article Abstract:

Studies show that asthma is underdiagnosed, and patients are often evaluated for respiratory symptoms between 16 to 20 times before a diagnosis of asthma is made. One study reported that the average duration between the first consultation (visit) for respiratory problems and diagnosis of asthma was 50.4 months. Another group of researchers demonstrated that the delay in diagnosis was equivalent to about 40 percent of the child's age. The delay in diagnosis of asthma was assessed in relation to time and number of consultations. In addition, the rates of consultation for respiratory problems before and after diagnosis of asthma were determined. The number of asthma cases were surveyed in two general practices; 212 cases of asthma were diagnosed in children between birth and 16 years. In most cases, a diagnosis of asthma was delayed by 2.95 years and was not made until the child had been evaluated 7 times. The number of consultations for respiratory symptoms initiated by patients decreased from 1.8 before diagnosis to 0.95 after diagnosis. However, the number of physician-initiated consultations increased from none before diagnosis to 1.01 after asthma diagnosis. The overall rates of consultation before and after diagnosis were unchanged. Efforts should be made to decrease the delay in diagnosis and thereby reduce the disability associated with childhood asthma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Diagnosis, Medical examination, Respiratory system, Respiratory organs, Pulmonary manifestations of general diseases, Respiratory symptoms

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