A CONFIDENTIAL INQUIRY INTO DEATHS CAUSED BY ASTHMA IN AN ENGLISH HEALTH REGION - IMPLICATIONS FOR GENERAL-PRACTICE

Aim. To determine the factors contributing to death from asthma in pat ients aged under 65 years in East Anglia in the early 1990s. Method. W e have performed an ongoing confidential enquiry since January 1992. F or the first time a general practitioner was included in the enquiry t eam. Results. A review of the clinical and pathological data of the 50 patients reported in the first 3 years suggested that 36 of these dea ths were attributable to asthma. Thirty-one patients died out of hospi tal (3 en route to the hospital), 2 in the Accident and Emergency depa rtment, and only 3 in hospital. Adverse social factors were found in 2 5 out of 34 patients, and adverse psychological characteristics in 23 of the 31 patients where these could be assessed. Only 7 appeared to h ave no adverse psychological or social factors. Routine medical care w as considered appropriate in 20 patients, and inappropriate in 14. Twe nty-four had received appropriate advice and education. Nine of the 21 patients, where this could be assessed, and half the relatives, faile d to respond appropriately to worsening asthma symptoms during the fat al attack. No potentially preventable factors were identified in two w omen who died of end stage asthma. Conclusion. This enquiry has demons trated that inadequacies in the medical care of asthma continue to occ ur, although less frequently than in previous asthma-death studies. In addition, 79% of the patients had experienced psychosocial factors wh ich appeared important in contributing to their deaths. Recommendation s for identifying and managing such 'at risk' patients have been circu lated to all general practitioners and chest physicians in the region.