Characteristics of near‐fatal asthma in childhood

As part of the South Australian asthma mortality survey, we examined 30 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 1991. Subjects 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 standardized interview and questionnaire was completed with subjects/parents and medical practitioners. Data were reviewed by the assessment panel which made collective judgments based on predetermined criteria. Seventeen patients (57%) were male, 20% were less than 7 years of age, and 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 significant 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 subjects or their families had high denial scores, and in 73% of cases psychosocial 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 preventable 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. Pediatr Pulmonol, 1995; 20:1–;8 © 1995 Wiley‐Liss, Inc.