The Child Death and Serious Injury Review Committee has reviewed the deaths of 14 children and young people since 2005, resulting from asthma.
The Committee found that improvements in asthma care could be made.
Recognition of poorly controlled asthma
Health services can help families and service providers caring for children with asthma to recognise extended periods of poorly controlled asthma through:
- Education of families about the importance of regular reviews by a paediatric respiratory specialist.
- Training programs for general practitioners and paediatricians about recognition of, and action during extended periods of poorly controlled asthma.
Hospital admission or emergency presentation as a trigger for medical review
The Australian Asthma Handbook1 recommends that admission to a hospital or presentation to an emergency department with asthma-related diagnoses should trigger a medical review of a child’s asthma within 2-4 weeks.
Health services can improve the quality of their care to children with asthma by:
- Monitoring the medical follow-up of all children discharged from high dependency or intensive care units by a paediatric respiratory specialist.
- Monitoring the medical follow-up of children within 2-4 weeks of admission to hospital or presentation at an emergency department by a primary medical practitioner (general practitioner, paediatrician or paediatric respiratory specialist).
- Assertive follow-up of children from vulnerable families who were admitted to hospital or presented to an emergency department with asthma.
Specialist care of children with poorly controlled, severe or unstable asthma
Health services can assist children to get the care they need by ensuring all children with poorly controlled, severe or unstable asthma are under the long-term care of a paediatric respiratory specialist. This may include the use of telehealth services in rural settings.
Ambulance attendance
The National Asthma Council of Australia recommends that an ambulance be called for a child having an asthma attack2. Ambulance services can assist families by:
- Establishing free ambulance services for families that qualify for pension concessions.
- Making available to families information about agencies that might reimburse fees for ambulance attendance.
Who is involved in caring for children with asthma?
- Children and young people with asthma
- Families and carers
- Paediatric respiratory specialists
- General practitioners
- South Australian health services
- South Australian education services
- South Australian ambulance services
- South Australian child protection services
- Peak bodies including the Royal Australian College of General Practitioners and Asthma SA
Facts about asthma
Australia has one of the highest rates of asthma in the world3. Global mortality due to asthma fell by 57% from 1993 to 2006 in 3-34 year olds, but has plateaued since that time4. The fall in asthma mortality around the turn of the millennium is attributed to:
- A change in medical management of asthma
- Restriction in the use of particular reliever medications (high-dose, poorly selective β2-agonists)
- The availability of ongoing preventative treatment (inhaled corticosteroids)5.
Asthma is a chronic inflammatory disorder of the airways. People with asthma experience episodes of wheezing, breathlessness and chest tightness due to widespread narrowing of the airways6.
Asthma
symptoms including wheeze, persistent cough, and breathing difficulty that are
frequent, persistent or severe may indicate poorly controlled, severe or
unstable asthma. Symptoms are interpreted differently according to the age of
the child.
There has been a decrease in admissions to hospital between 2005 and 2016 for asthma-related diagnoses (Figure 1).
Figure 1: Separations from hospital for asthma
The number of separations from intensive care for children with an asthma-related diagnosis decreased between 2009 and 2016 (Figure 2).
Figure 2: Separations from intensive care for asthma
Source: Integrated South Australian Activity Collection (ISAAC), SA Health
Useful asthma care websites
The National Asthma Council Australia – https://www.nationalasthma.org.au/
The Australian Asthma Handbook – https://www.asthmahandbook.org.au/
Asthma Australia – https://www.asthmaaustralia.org.au/national/home
AIHW Asthma snapshot – https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/contents/asthma
United Kingdom Royal College of Physicians. Why asthma still kills. The National Review of Asthma Deaths. 2014. Healthcare Quality Improvement Partnership – https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
Footnotes
- Australian Asthma Handbook. https://www.asthmahandbook.org.au/management/children/routine-asthma-reviews Accessed 9 May 2019
- The National Asthma Council. https://www.nationalasthma.org.au/asthma-first-aid Accessed 9 May 2019
- Poulos, LM, Toelle, BG, Marks, GB. The burden of asthma in children: an Australian perspective. Paediatric Respiratory Reviews.2005, 6: 20-27.
- Jenkins, C. Eliminating asthma deaths: have we stalled? Commentary. Lancet 2017, volume 390: 915-6.
- Ebmeier, S., Thayabaran, D., Brathwaite, I., Benamara, C., Weatherall, M., Beasley R. Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993-2012). www.thelancet.com. Published online August 7, 2017 http://dx.doi.org/10.1016/S0140-6736(17)21448-4
- Australian Institute of Health and Welfare 22 Dec 2017, Asthma, viewed 25 May 2018 https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/contents/asthma