A Confidential Enquiry into Deaths Caused by Asthma in an English Health Region: Implications for General Practice

Aim: To determine the factors contributing to death from asthma in patients aged under 65 years in East Anglia in the early 1990s.

Method: We have performed on ongoing confidential enquiry since January 1992. For the first time a general practitioner was included in the enquiry team.

Results: A review of the clinical and pathological data of the 50 patients reported in the first 3 years suggested that 36 of these deaths were attributable to asthma. Thirty-one patients died out of hospital (3 en route to the hospital), 2 in the Accident and Emergency department, and only 3 in hospital. Adverse social factors were found in 25 out of 34 patients, and adverse psychological characteristics in 23 of the 31 patients where these could be assessed. Only 7 appeared to have no adverse psychological or social factors. Routine medical care was considered appropriate in 20 patients, and inappropriate in 14. Twenty-four had received appropriate advice and education. Nine of the 21 patients, where this could be assessed, and half the relatives, failed to respond appropriately to worsening asthma symptoms during the fatal attack. No potentially preventable factors were identified in two women who died of end stage asthma.

Conclusion: This enquiry has demonstrated that inadequacies in the medical care of asthma continue to occur, although less frequently than in previous asthma-death studies. In addition, 79% of the patients had experienced psychosocial factors which appeared important in contributing to their deaths. Recommendations for identifying and managing such "at risk' patients have been circulated to all general practitioners and chest physicians in the region.