Deaths from Asthma in Childhood: Can They Be Predicted?

We have used a case-controlled study to clarify positive, as well as negative, clinical characteristics of children who die with asthma. Variables discriminating between 21 patients who died from asthma and 21 asthmatic control cases matched for age, sex, and severity of illness were: 1) seizures with asthma attacks (p < 0.01); 2) large reductions in prednisone dose (p < 0.01); 3) disregard of wheezing (p < 0.06); 4) increased asthma in the week before discharge (p < 0.05); 5) poor self-care (p < 0.01); 6) parent/staff conflict (p < 0.01); 7) depressive symptoms (p < 0.05); 8) use of inhaled beclomethasone (p < 0.05); 9) patient/staff conflict (p < 0.01); 10) patient/parent conflict (p < 0.05); 11) manipulative use of asthma (p < 0.01); 12) emotional disturbance (p < 0.01); 13) history of reaction to separation or loss (p < 0.01); and 14) family dysfunction (p < 0.05). Most of the clinical characteristics previously thought to place patients at greater risk for a fatal asthmatic attack were equally frequent in the children who died and the control cases. This study indicates that psychological risk factors were prominent in severely asthmatic children who subsequently died of asthma.