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Scottish
Confidential Inquiry into Asthma Deaths (SCIAD)
Correspondence to: Dr C E Bucknall, Department of Respiratory Medicine, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK.
Received 7 January 1999; Returned to authors 3 March 1999; Revised version received 24 June 1999; Accepted for publication 25 June 1999
BACKGROUND
There have
been important changes in the organisation of care for patients with
asthma since asthma deaths were studied in the 1980s by the British Thoracic Association (BTA), with greater emphasis on long term control of symptoms and the use of preventive therapy. Recent trends in routine statistics show a decline in population death rates.
METHODSA confidential
review was undertaken of general practice and hospital records and
interviews with general practitioners of patients dying in mainland
Scotland between January 1994 and December 1996 with a principal
diagnosis of asthma recorded by the Registrar General's Office. Panel
assessment of the cause of death was carried out and a number of
possible adverse factors were identified. The data from the 15-64 year
age group were compared with similar data from the earlier study by the BTA.
RESULTSOver the three
year period 95 deaths of 235 studied (40%) were confirmed as being due
to asthma. Taking account of different methods of case ascertainment
used in the BTA and this study, a fall in the calculated rate of
"deaths assessed as due to asthma" was found from 2.51 (95% CI
2.34 to 2.68) per 100 000 population in 1979 to 1.26 (95% CI 1.19 to
1.33) per 100 000 population in 1994-6. Fewer individual adverse
factors were identified in clinical management, with appropriate
routine management in 59% and management of the final attack
satisfactory in 71%. Patient factors such as poor compliance, lack of
peak expiratory flow (PEF) measurements, and overuse of reliever
medication without inhaled corticosteroids, and psychosocial problems,
notably depression, were confirmed as important contributing factors.
Four of five patients under 16 years of age who died were found to have
problems with routine management.
CONCLUSIONSThis
population based study documents important improvements in the standard
of asthma care as well as a significant decline in the rate of deaths
due to asthma over a period during which the organisation of care has
changed and the chronic nature of the disease has been acknowledged.
Strategies which might have a further impact include the greater use of
PEF recordings, particularly during acute attacks, to document
recovery, prescription monitoring of the underuse of inhaled
corticosteroids, consideration of the use of combined preparations
where persistent overuse of bronchodilators is occurring, and increased
input for young patients whose routine management is proving difficult.
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