Abstract
We 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 the following: (1) seizures with asthma attacks; (2) large reductions in prednisone dose; (3) disregard of wheezing; (4) increased asthma in the week before discharge; (5) poor self-care; (6) parent/staff conflict; (7) depressive symptoms; (8) use of inhaled beclomethasone; (9) patient/staff conflict; (10) patient/parent conflict; (11) manipulative use of asthma; (12) emotional disturbance; (13) history of reaction to separation or loss; and (14) family dysfunction. Patients with 7 of the 14 variables (or 3 of the first 7 variables) were considered at high risk for dying. A special protocol focusing on psychological risk factors was designed to approach these patients. A three-year experience with the identification system and intervention strategy suggests that patients at risk can be successfully identified and that deaths can be prevented.
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