A DISTRICT CONFIDENTIAL INQUIRY INTO DEATHS DUE TO ASTHMA

Background-The aim was to establish a continuing district based confid ential enquiry into deaths from asthma. Methods-A confidential enquiry was conducted in an English health district. Subjects comprised 24 re sidents of the Norwich health district aged between 16 and 65 years wh o had died between 1988 and 1991 with asthma as the principal cause of death. Results-Twenty one of the patients (88%) died away from hospit al. Overall the routine asthma management was appropriate in all respe cts in only four patients. In five cases the drug treatment was consid ered inappropriate, in 10 cases (42%) there was no written evidence th at the patient had received advice and education, and only six cases h ad a written management plan. In 17 patients (71%) the fatal attack of asthma developed rapidly (in under three hours). The medical care dur ing the final attack was found to have been inappropriate in six cases . Seventeen cases (71%) had psychological or social factors that were considered to have been of potential importance. Conclusions-This stud y has shown the feasibility of organising a confidential enquiry into asthma deaths within a health district. The distinguishing features of such an enquiry are that it is continuing, that the quality of care g iven to those patients who died is compared against a recognised stand ard, and that there is a structured system for feeding back the conclu sions of the enquiry to the local medical community.