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

Abstract

Background: Confidential enquiries into asthma deaths can identify inadequacies in medical management and factors which contribute to patients' death.

Aims: To identify risk factors for paediatric asthma deaths over a 6-year period.

Methods: Observational case-series study of paediatric asthma deaths between 2001-2006 in the UK Eastern Region. Hospital, primary care and post-mortem data were obtained for every child (≤17 yrs) with asthma recorded on the death certificate, and a detailed questionnaire was completed. Information was obtained on asthma severity, medications, hospital admissions, GP and hospital follow-up, adherence, psychosocial / behavioural factors, allergies, details of the terminal attack and precipitating factors.

Results: 20 children (10 male; 8-17 yrs; median: 11.5 yrs) died of asthma between 2001-2006. 9/20 had mild to moderate asthma (BTS/ SIGN criteria), 10/20 had severe asthma and 1 child was not known to have asthma. 13/20 were clinically atopic. Only 3 had undergone allergy assessment. 10/20 died between June and August. 12/20 children had adverse psychosocial and behavioural factors. 7/20 children were on non-combination long-acting β2-agonist (LABA) treatment without inhaled corticosteroids (ICS).

Conclusions: Almost half the deaths occurred in children with mild/moderate asthma. We recommend that allergic factors and seasonal allergy should be identified early, non-combination LABAs avoided, and speculate that overuse of short-acting β2-agonists (SABAs) may indicate non-adherence with ICS. Asthma deaths in children can be avoided if risk factors are identified early.

Figure 1. Asthma severity including number of children with previous hospital admissions in each group (mild, moderate, severe)

Figure 2. Number of asthma deaths in different months; there is a clear peak in the months of June/July/August which most likely represents seasonal asthma