Harrison Brian, Stephenson Paul, Mohan Govind, Nasser Shuaib
Norfolk and Norwich University Hospital, Norwich.
Prim Care Respir J. 2005 Dec;14(6):303-13. doi: 10.1016/j.pcrj.2005.08.004. Epub 2005 Oct 11.
The Eastern Region Confidential Enquiry into asthma deaths started in 2001. It incorporates the Norwich and East Anglian Enquiries started in 1988 and 1992, respectively. The aim of this study was to analyse all asthma deaths in the Eastern region between 2001 and 2003, to elicit any factors contributing to the patients' deaths, and to make comparisons with the previous Norwich and East Anglian data.
Patient details were obtained for all deaths in the Eastern Region under the age of 65 with asthma recorded in the first part of the death certificate. Patients' notes were reviewed by members of the Working Group - a consultant chest physician and a general practitioner (GP). In most cases, the patient's GP was contacted. Data were obtained on the patients' asthma care, asthma severity, terminal attack, psychosocial and behavioural factors, allergies, precipitating factors, and post-mortem findings. The quality of medical care was assessed and compared with national guidelines.
Total study population was 5.25 million. Only 57/95 notified deaths (60%) were confirmed as asthma deaths. 311 asthma deaths have been studied between 1988 and 2003. In 2001-2003, male:female ratio was 3:2. Further data were unavailable on three cases. 53% of patients had severe asthma and 21% moderately severe disease. In 19 cases (33%) at least one significant co-morbid disease was present. Monthly death rates peaked in August, with a smaller peak in April. In 11 cases (20%), mostly males aged under 20, the final attack was sudden and 10/11 occurred between April and August. In 81% of cases there were significant behavioural and/or psychosocial factors such as poor compliance (61%), smoking (46%), denial (37%), depression (20%) and alcohol abuse (20%). The overall medical care of the patient was appropriate in 33% of cases.
Between 1988 and 2003 there was a downward trend in asthma mortality rate in East Anglia. In 2001-2003, misclassification of deaths attributed to asthma was still common. Most patients who die of asthma have severe asthma. In 81% of cases, behavioural and psychosocial factors contributed to the patient's death. In 80% of deaths the final attack was not sudden, and may have been preventable. Almost all sudden deaths occurred between April and August, suggesting a seasonal allergic cause. In two-thirds of asthma deaths, medical management failed to comply with national guidelines. 'At-risk' asthma registers in primary care may improve recognition and management of 'at-risk' patients.
东部地区哮喘死亡机密调查始于2001年。它纳入了分别于1988年和1992年启动的诺维奇及东安格利亚调查。本研究的目的是分析2001年至2003年期间东部地区所有哮喘死亡病例，找出导致患者死亡的任何因素，并与之前诺维奇及东安格利亚的数据进行比较。
获取了东部地区所有65岁以下、死亡证明第一部分记录有哮喘的死亡病例的详细信息。工作组的成员——一位胸科顾问医师和一位全科医生（GP）查阅了患者病历。在大多数情况下，还联系了患者的全科医生。获取了有关患者哮喘护理、哮喘严重程度、终末期发作、心理社会和行为因素、过敏、诱发因素以及尸检结果的数据。评估了医疗护理质量并与国家指南进行比较。
研究总人口为525万。在95例已通报的死亡病例中，仅57例（60%）被确认为哮喘死亡。1988年至2003年期间共研究了311例哮喘死亡病例。2001 - 2003年，男女比例为3:2。有3例无法获取更多数据。53%的患者患有重度哮喘，21%患有中度重度疾病。19例（33%）患者至少有一种严重的合并症。月死亡率在8月达到峰值，4月有一个较小的峰值。11例（20%）患者，大多为20岁以下男性，终末期发作突然，其中10/11例发生在4月至8月之间。81%的病例存在显著的行为和/或心理社会因素，如依从性差（61%）、吸烟（46%）、否认（37%）、抑郁（20%）和酗酒（20%）。33%的病例中患者的总体医疗护理是恰当的。
1988年至2003年期间，东安格利亚的哮喘死亡率呈下降趋势。2001 - 2003年，归因于哮喘的死亡误分类仍然很常见。大多数死于哮喘的患者患有重度哮喘。81%的病例中，行为和心理社会因素导致了患者死亡。80%的死亡病例终末期发作并非突然，可能是可预防的。几乎所有突然死亡都发生在4月至8月之间，表明存在季节性过敏原因。三分之二的哮喘死亡病例中，医疗管理未遵循国家指南。基层医疗中的“高危”哮喘登记册可能会改善对“高危”患者的识别和管理。
