CHARACTERISTICS OF NEAR-FATAL ASTHMA IN CHILDHOOD

As part of the South Australian asthma mortality survey, we examined 3 0 cases of near-fatal asthma attacks in children under 15 years of age who were seen over a 3-year period from May 1988 to June 1997. Subjec ts presented with asthma and either respiratory arrest, PaCO2 above 50 mm Hg, and/or an altered state of consciousness or inability to speak on presentation at a metropolitan Adelaide teaching hospital. A stand ardized interview and questionnaire was completed with subjects/parent s and medical practitioners. Data were reviewed by the assessment pane l which made collective judgments based on predetermined criteria. Sev enteen patients (57%) were male, 20% were less than 7 years of age, an d the majority (53%) were aged between 12 and 15 years. The majority ( 83%) had severe asthma and only one case (3.3%) had mild asthma. Half of the subjects were waking every night due to asthma and 79% had sign ificant exercise limitation. A quarter of the subjects had a previous ICU admission and 70% had a hospital admission in the last 12 months. Primary care was carried out by a general practitioner in 57% of cases , and 70% of subjects had a crisis plan. Only 46% of those older than 7 years of age had ever used a peak-flow meter. Eighty percent of subj ects or their families had high denial scores, and in 73% of cases psy chosocial factors were considered to be significant. Eighty percent of cases experienced acute progressive respiratory distress, and 63% of cases delayed seeking medical care. The episode was judged as preventa ble in 83% of cases. This study suggests that most pediatric cases of near-fatal asthma have severe asthma, significant denial, psychosocial pathology, and delay in seeking care, all of which contribute to the near-fatal nature of these episodes. (C) 1995 Wiley-Liss, Inc.