Medication usage and severe exacerbations
Half of the children were prescribed a daily controller medication and
the other half were only prescribed controller medication with symptoms.
Six patients had picked up a controller medication in the year before
their death with adherence, defined as days of controller medication
filled/365, ranging from 8% to 47% (median 33%) in those prescribed
to be on a daily controller medication. All had picked up more than 2
SABA inhalers (range 800 to 2000 doses). Prescriptions for SABA were
filled a median of 9 days prior to the day of death (range 4 to 60 days)
with seven children filling the prescription within a month of their
death including three children who reportedly had good control and
during their terminal event were described as having sudden onset of
death from asthma. 75% of patients had multiple providers prescribing
short-acting beta agonists.
6 children had a severe exacerbation (hospitalization, ED visit, or
course of systemic steroids) in the year before their death with only
one having a lifetime history of an ICU admission.