Most severe asthma attacks and deaths in childhood can be prevented.
A 10 year old boy’s death due to asthma was potentially preventable. We need to take action to reduce risk to prevent severe attacks and deaths. This applies to doctors and nurses caring for children and also by parents. My podcast summary, the coroner’s report and a number of press articles provide details of this very sad story.
The coroner concluded that: ”William Gray died as a consequence of failures by healthcare professionals to recognise the severity and frequency of his symptomatology and the consequential risk to his life that was obvious. William’s death was contributed to by neglect. William’s death was avoidable. There were multiple failures to escalate and treat William’s very poorly controlled asthma by healthcare professionals that would and should have saved William’s life.” Source https://www.judiciary.uk/prevention-of-future-death-reports/william-gray-prevention-of-future-deaths-report/
Increase awareness of risk to prevent asthma attacks
Details of this boy’s care reported by the coroner repeat those in other reports on asthma deaths. Preventable factors in asthma deaths were first reported in the UK 60 years ago. There have been a number of similar reports in the UK and internationally since then.
A key issue in this case was that the boy had a life threatening attack 7 months before his fatal attack. The coroner reported that William was treated for four more attacks by his doctor without referral to a respiratory specialist.
Anyone having a severe life threatening asthma attack is at risk of another one.
The National Review of Athma Deaths (NRAD 2011-2014) recommended that two or more asthma attacks in a year should trigger referral to an asthma specialist. This did not happen in this boy.
I was the coroners expert witness in the inquest on Tamara Mills who died just before her 14th birthday just 4 months after she had a life threatening asthma attack. She had had 47 attacks in her last 4 1/2 years. None of the doctors referred her to a specialist when she presented in Accident and Emergency (ED) twice during the week she died. I was also expert witness in the inquests of Michael Uriely and Sophie Holman who also died shortly after severe asthma attacks. Michael had six attacks in the year before he died and a further two in the year that he died. Sophie had 48 attacks in her short 10 years of life. Neither were referred to an asthma specialist.
U.K coroners issue Regulation 28 statements where there are lessons to prevent future deaths. I’m aware of at least five regulation 28 statements in the last 10 years. These were in the news for a few days without any sustained national action to protect children with asthma.
Politicians and health care managers in the UK have not changed the management of asthma. Please listen to my podcast on this sad case and share it.
An asthma attack is a signal that something serious has gone wrong!
Three things Doctors and Nurses can do to prevent asthma attacks:
- Identify and deal with modifiable risk factors – during and after attack management
- Refer to asthma specialist if two or more attacks in a year
- Refer to specialist if poorly controlled despite high dose medication
Three things Parents can do to prevent asthma attacks:
- Take asthma seriously
- Ensure you have a self management plan
- Ensure you collect your child’s preventer medication and watch your child take their preventer inhaler
Treatment of attacks includes BOTH management of the attack and ALSO identification and management of avoidable risk factors by someone trained in asthma care
| Some key modifiable risk factors for poor asthma outcome (full list in Box 2-2 ) |
| Insufficient preventer inhaler prescription |
| Excess reliever prescriptions ( if more than 2 in 12 months – urgent review) |
| Poor inhaler technique |
| Lack of acute self management plan |
| Asthma attacks |
A post-attack review by someone trained can identify modifiable risk factors needing action.