The circumstances preceding death from asthma in young people in 1968 to 1969

Abstract

The circumstances preceding death from asthma were investigated in 52 young persons aged 5 to 34 years dying in Greater London and the South-East Lancashire conurbation between February 1968 and January 1969. Information was gathered at interviews with general practitioners, hospital staff, and relatives or witnesses of the last hours of life. The findings at necropsy were obtained from coroners or hospital pathologists. All the patients were severely affected; most had required regular medication to control their asthma, many had been in hospital for an acute attack and many were deteriorating before death. Despite this, death was regarded as ‘sudden and unexpected’ in at least 79% of patients and it seems probable that the severity of their condition was often not recognized by patients, relatives, and doctors. Several publications have suggested that sudden death has been associated with overdosage by pressure-packed aerosols containing sympathomimetic bronchodilators, and specific enquiries were made about their use. In 11 of 30 cases (37%) in which sufficient information was available the evidence suggested that excessive inhalation of bronchodilators might have contributed to death. Ten of these patients had used a pressure-packed aerosol containing a sympathomimetic bronchodilator and one other patient had inhaled disodium cromoglycate with added isoprenaline. Throughout the period of the investigation the mortality from asthma showed a sharp and continuing decline and it is estimated that less than half the deaths studied (46%) would have been caused by the epidemic factor. Apart from an occasional report of compulsive use, the principal reason for overdosage appears to have been failure to appreciate the lack of a normal response is an indication for a different type of treatment and management and not an indication to increase the dose. No other factor was discovered which might have caused the observed increase in mortality.