Is My Child at Risk of a Fatal Asthma Attack?

Surprising factors increase risk in vulnerable children

coughing child
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Advances in asthma treatment and management have resulted in a significant decline in asthma-related deaths in the United States, dropping from 2.1 deaths for every 10,000 patients in 2001 to only 1.4 deaths for every 10,000 in 2009. That’s a vast improvement from the early 1990s when the asthma death rate was at its peak.

Despite this turnaround, the rate of hospitalization in children with asthma remains far higher than adults.

The same applies to the rate of emergency care, outpatient care, and the number of severe attacks. The only measure for which adults exceeded children was mortality rates, and that’s a positive thing.

In 2007, for example, despite experiencing more attacks overall (57 percent vs. 51 percent), only 185 children died of asthma that year compared to 3,262 adults. The reasons for are many, including higher rates of lung disease in adults and the closer medical surveillance o children in general.

But, at a time in history when asthma-related fatalities are almost entirely preventable, even 185 deaths are too much. And, tragically, many of these deaths were less related to the severity of an attack and more to how the attack was treated.

Factors Related to Child Asthma Deaths

The incidence of asthma among children is not evenly distributed. Studies have shown that low-income, African American children not only have a higher rate of asthma when compared to white children, they also have the highest rate of asthma-related deaths.

There is a cause-and-effect explanation for this racial disparity:

  • Poor families have less access to health care, including asthma-specific care.
  • Environmental pollutants tend to be higher in lower-income communities.
  • Crowded living conditions can lead to an increased exposure to allergens and infections, resulting in greater exacerbations.

    The current statistics also show that only a third of these pediatric deaths occurred in hospital. This would suggest that families either had little or no access to inpatient or emergency care or had little idea as to identify or treat a potentially deadly exacerbation.

    Moreover, the inconsistent access to treatment only enhances the likelihood and frequency of these attacks. It’s a vicious cycle that places our most vulnerable children at greatest risk.

    Knowing When to Seek Urgent Care

    None of these statistics should suggest that race and poverty are the only factors that place a child at risks. Ultimately, the same risks would apply to any children whose asthma is not being controlled, whether due to inconsistent care, the underuse of rescue medications, and the failure/inability to avoid the environmental triggers.

    There is also the simple fact that some children with asthma are sicker than others. In these children, who may be all too familiar with emergency rooms and hospital visits, the specter of a severe, even fatal attack may seem a very real possibility. But, even for those these children, fatalities are more associated more with missed symptoms and/or delayed treated than anything else.

    According to the research:

    • Between 80 percent and 85 percent of children who died from asthma had progressive symptoms anywhere from 12 hours to several weeks before their deaths.
    • By contrast, fewer than one in five died of a sudden, acute attack within six hours of developing symptoms.

    What this tells us is that death is less likely to come "out of the blue" but rather in a timeframe where treatment can usually be sought. This doesn’t suggest that the parents were complacent; it simply punctuates the dangers that insufficient health care places on a child with severe asthma.

    Risk Factors for Asthma-Related Death

    There is actually little available research on the risk factors associated with pediatric asthma deaths, in part because deaths tend to occur more in adults.

    With that being said, there are risk factors that increase the risk of death in anyone living with severe asthma:

    • Previous history of a near-fatal asthma event
    • Frequent and severe asthma symptoms
    • Poorly controlled asthma with increased shortness of breath, sleep interruptions, and frequent rescue inhaler use
    • Prior severe asthma attack requiring intubation or admission to intensive care
    • Two or more asthma-related hospital admissions or three or more emergency room visits related to asthma
    • Using two or more canisters of short-acting bronchodilators within a month
    • Co-occurring health problems like congenital heart disease or lung disease
    • African American race
    • Poverty and lack of healthcare access

    Reducing Risk in Children With Asthma

    Even when faced with severe and/or frequent exacerbation, the risk of death can largely be erased by formulating a clear asthma action plan and keeping to it vigilantly.

    This includes the routine use of a peak flow meter (PFM) even when the child’s asthma seems under control. It’s not unusual, for example, to hear children say that they "don’t need it anymore" because they "feel just fine." That’s not the point. The point is to make its use so routine so that it becomes an inherent part of management rather than something you reach for in a crisis.

    The same attitudes apply to you as a parent. Certainly, as caregivers, it's fair to hope that our children will one day outgrow their asthma. But it's important not to grasp at signs of improvement as evidence of a turnaround. Work with your doctor and keep monitoring your child's condition as a matter of course. That includes annual flu vaccinations, regular doctor visits, and the avoidance of any asthma triggers in your everyday life.

    By doing so, you'll be better prepared to deal a severe attack if one occurs and will instinctively know when it's time to act and seek emergency care.

    Sources:

    American Academy of Allergy, Asthma, and Immunology. "Asthma Statistics." Milwaukie, Wisconsin; updated 2016.

    Guilbert, T.; Bacharier, L.; and Fitzpatrick, A. "Severe Asthma in Children." Journal of Allergy and Clinical Immunology: In Practice. 2014; 2(5):489-500.

    Rosenman, K.; Hanna, E.; Lyon-Callo, S.; et al. "Investigating Asthma Deaths Among Children and Young Adults: Michigan Asthma Mortality Review." Public Health Review. 2007; 122(3): 373–381.

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