Child Asthma Deaths Rates Double

by Diane Duke
Washington University

"It's pretty clear that the parents don't pay attention when their child has bad asthma. Conflict or disorder in the family prevents good care or enhances the possibility of recognizing things late. Children just get trapped," said Strunk, a professor of pediatrics at Washington University School of Medicine in St. Louis.

The vast majority of those deaths could have been prevented by appropriate care and planning. Strunk also has identified children who are most likely to die. Looking at published studies, he compared children who had died with children who had asthma just as severely but were still alive. His review of the studies appeared in the journal Immunology and Allergy Clinics of North America.

These families do not have one particular kind of problem. They may be struggling with the recent loss of a loved one, alcoholism, unemployment, spousal abuse or other issues, added Strunk.

In the other type, deaths are sudden and unexpected. These patients do not have symptoms of severe asthma before the onset of the fatal attack.

Strunk and his colleagues keep a list of fatality-prone children, testing their function on a regular basis. "The bottom line in deciding who is fatality-prone is really doctors' and nurses' gut feeling about a family," he said. "Everyone knows there's a list and, if those patients call, the secretaries pay special attention and get someone right away."

Aside from having severe asthma, children's attitudes about the disease can determine whether they will die from the disease. Many of these children are depressed and sad about having the disease, disliking how their lives are interrupted by asthma.

"Children with asthma learn how to think about the disease from their parents. I think the family issues are paramount," Strunk said. He sees children in the asthma clinic with severe disease whose families are organized and work well together. The children may not be participating in active sports because their asthma is so severe, but they are happy, going to school every day and looking forward to life.

He also sees children with asthma that's not as severe but is completely out of control. These patients are in and out of the hospital, and they're not focusing on taking care of their asthma.

Even if a child is adhering to a medical regimen and is improving, physicians and nurses must stress chronic care because asthma may come and go but rarely disappears. Therefore, families should be counseled about the importance of contacting a physician and promptly treating symptoms.

The effectiveness of asthma therapy must be checked regularly by both pulmonary function testing and making sure the treatment allows participation in school activities and minimizes school absences.

Patients who are at high risk of dying should be followed more closely, Strunk said. They should have pulmonary function tests at each physician visit and a peak flow meter at home for regular use. The child's parents should know the seriousness of the illness, and an asthma action or crisis plan should be developed for acute attacks.

"In spite of better understanding and newer treatments, deaths continue to occur," Strunk said. "These families have to pay attention, get organized and learn to communicate with each other."