Abstract
In 2007, three cases of asthma death in childhood and adolescence were newly registered in The Committee on Asthma Death in Children of Japanese Society of Pediatric Allergy and Clinical Immunology. Thus the total number of 218 cases with asthma death was enrolled since 1989. According to the most recent Japan's demographic statistics reported by the Ministry of Health, Labour and Welfare, the mortality rate of asthma in infants and young children (≤4 years of age) have been steadily decreasing during the period between 1980 and 2002. However, thereafter the rate of asthma death has not satisfactorily declined although it is very small (i.e., 0.1-0.4 /100,000 persons). To determine the risk and predictive factors of asthma death in infants and young children, all cases of asthma death with ≤5 years of age (40 cases), enrolled in the committee since 1989, were surveyed. The following results were obtained.
1) Of 40 cases with asthma death, male and female cases were 24 and 16, respectively. Among all cases of asthma death, seven males and two females were enrolled during the period between 1998 and 2006.
2) An average of age at asthma death was 2.2 years and that of periods between onset, diagnosis of asthma and death was 1.1 and 0.7 years, respectively.
3) Disorders of cardiovascular or central nervous systems were associated with 15 % of all cases of asthma death.
4) Asthma attack requiring hospital admission occurred during one year before asthma death in 45 % of all cases. However, only a small number of cases had episodes of severe asthma attack with unconsciousness or requiring artificial ventilation and so on.
5) None of the cases had received inhaled glucocorticosteroids although some anti-allergic drugs, including disodium cromoglycate, were given in a small number of cases with asthma death.
6) More than 70% of all cases dyed of asthma in the hospitals where they usually visited.
Diagnosis and management of asthma are difficult in children at 5 years or younger. Such problems should be resolved by pediatric allergists as soon as possible. This survey clearly indicates that early therapeutic intervention is needed to prevent asthma death. In addition, it is difficult to determine the precise mortality rate of asthma in infants and young children probably because asthma death occurring in the first attack has been easily missed and asthma attack is not necessarily the cause of death in asthmatic patients. Therefore, we should pay more attention to determine the causes of death in infants or younger children with asthma.
