Sudden death in asthma in childhood

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Abstract

Death from asthma in childhood is rare, occurring in approximately 1 in 10 000 affected children. While most deaths occur in hospitalised children with severe asthma, it has been reported that sudden and unexpected death may occur in children with only mild disease. In this study the clinicopathological features of 11 cases of sudden death taken from the files of the Adelaide Children's Hospital over a 30-year period are reported. Children were aged between 3 years 10 months and 15 years 2 months (average = 9 years 9 months), with a male to female ratio of 5:6. Deaths occurred either at home, in an ambulance or within minutes of arriving in the Emergency Department. Viral respiratory tract infections were common associated findings. While one child was considered to have only mild disease, most children had long histories of asthma and had required prolonged medication or hospitalisation. The demonstration of growth retardation (i.e. height or weight < 3rd percentile) in 73% of cases is also supportive of long-standing severe asthma being present. Thus, in this series, sudden and unexpected death occurred only in children with significant chronic disease. In formulating the diagnosis of sudden death due to asthma in children, delaying growth parameters may, therefore, be an additional useful morphological marker indicating an at-risk child.

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    Citation Excerpt :

    At the time of the autopsy, such microscopic anomalies were not observed in our series; probably, such lesions may be related to a higher sensibility of adrenal glands to chronic steroids therapy in young individuals [23], the population of our series being older (average of 39.3 years old). The 11 cases of asthma-related sudden death in Australian children were studied by Champ and Byard [24] presented the same male predominance (male/female ratio of 5/6), death localization (at home, on the way to the hospital or just at the arrival in the emergency room), but the authors noted a growth retardation present in 73% of their cases (height or weight > 3rd percentile), delaying growth parameters being considered as an additional useful morphological marker indicating at at-risk child. As a matter of fact, chronic inhaled corticoids may be at the origin of such a reduction in final height, i.e. a collateral effect of long-term treatment [23].

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