Unexpected death in childhood asthma. A review of 13 deaths in ambulatory patients
L. P. Kravis and G. B. Kolski
Between January 1969 and January 1984, there were 13 deaths in ambulatory
chronic asthmatics aged 9 to 19 years who had been followed up by
physicians of the Allergy Section, Children's Hospital of Philadelphia.
During this period, 5,686 children had been admitted to this institution
for treatment of acute asthma and all had survived. Three possible causes
for these deaths are suggested from a detailed review of each case. One
cause may be medication-related, as exemplified by patient abuse of inhaled
adrenergic drugs with concomitant erratic use of theophylline and
corticosteroid drugs, or by physician failure to appreciate the need for
corticosteroids. Serious behavioral disturbances account for some cases of
medication misuse. A second cause of death may be an unsuspected pulmonary
pathologic lesion, as revealed at autopsy, and a third cause may be sudden,
intense airway narrowing, as has been reported in near deaths in
hospitalized asthmatics.
