Thirty five asthma deaths in children aged 1 to 16 years were investigated in detail. Twenty four of these children had previously been under hospital consultant care and there were seven inpatient deaths. Twenty nine cases (83%) had a history of severe asthma, 17 of whom had previously experienced a life threatening attack. The fatal outcome, however, could not have been predicted in six children (17%) with preceding mild asthma. Potentially preventable factors in management were found in 28 cases (80%). While 18 (51%) had been chronically undertreated, the major factor in 20 deaths (57%) was suboptimal management of the final attack owing to delay in seeking medical attention, inadequate medical response, or both. Only two children had received systemic corticosteroid in appropriate amounts during the final illness. If mortality is to be reduced, families of asthmatic children must be educated to recognise severe symptoms and be given an appropriate 'crisis plan'. Hospitals should permit free access and have a clear protocol for the management of children with severe asthmatic attacks.
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