DISCUSSION
The number of pediatric deaths in this case series is similar to what
has been reported in other Canadian studies2 and is
lower than the number of deaths per population in the United
Kingdom1 and the United States 3 .
East/Southeast Asian ethnicities were over-represented as this ethnic
group only accounts for 8% of the population in British Columbia. The
predominance of deaths occurring in children aged 10 to 18 years old is
the same as reported in a recent UK inquiry1. All
children had severe anoxic brain injury due to out of hospital arrests
which identifies that in-hospital management of exacerbations is not
contributing to asthma deaths.
Given the rarity of asthma deaths despite the high prevalence of asthma
in children, it is important to note that all of the children in this
case series had identifiable risk factors for asthma death most
commonly: poor adherence to controller medication, overuse of
short-acting beta agonists, and a recent exacerbation. Although previous
studies identified that use of more than 12 inhalers of reliever in a
year increased the risk of death5, a recent study
found that this threshold is much lower with the use of more than 3
inhalers associated with an increased risk of death6,
which was seen in this series with all children filling more than 3
inhalers but none filling more than 12. A limitation of prescription
refill data is that it is not known if short-acting-beta-agonists were
used or if they were filled to have additional rescue inhalers on hand.
However, refills of rescue inhalers can act as an objective surrogate
for asthma control given it is known that patients often overestimate
their asthma control when asked7.
Asthma deaths were rare in children but attention should be paid to
those with a severe exacerbation (requiring systemic steroids, an ED
visit or hospitalization) in the past year, more than three beta-agonist
refills in a year and poor adherence to controller medication.
1, 4Yang, CL, MSc, MD
1Cook, VE, MSc, MD
3, 4Carleton, B, BSc, PharmD
2Seear, M, MD
1Division of Respiratory Medicine, Department of
Pediatrics, BC Children’s Hospital
2Division of Clinical Immunology and Allergy,
Department of Pediatrics, BC Children’s Hospital
3Division of Translational Therapeutics, Department of
Pediatrics, University of British Columbia
4BC Children’s Hospital Research Institute
Corresponding Author:connie.yang@cw.bc.ca
Word count 1335
Funding Statement: Financial support was provided in part by the
Therapeutic Evaluation Unit of the BC Provincial Health Services
Authority
Competing interests: None of the authors have competing interests for
the content of this paper
Word count (excluding abstract): 995
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