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Subjects with severe and unstable asthma are at high risk of fatal asthma attack. We describe a case of fatal childhood asthma in an 11-year old girl whose asthma was apparently stable with supranormal lung function and identify additional characteristics that should be considered as increasing the risk for fatal asthma. This opportunity was provided by this girl's participation in the Isle of Wight Whole Population Birth Cohort Study. Prospectively collected data identified her as an early-onset persistent wheezer with significant allergic comorbidity. She was highly atopic with multiple allergen sensitization and a total IgE exceeding 5000 Ku/L (normal range: 0-180 ku/l) at 10 years. Additionally at that age, whilst possessing normal lung function (FEV1 2.15 Litres; 110% predicted), she was found to have marked bronchial hyper-responsiveness (PC20 Methacholine 1.71 mg/ml). At the age of 11 years, despite apparent clinical stability and use of regular controller asthma therapy, she suffered a fatal acute asthma attack that may have been related to acute allergen exposure. This report provides further insight into factors associated with fatal childhood asthma. We propose that highly atopic children with early onset persistent asthma are at a higher risk of fatal asthma even if their asthma is apparently stable and lung function is normal. Marked bronchial hyper-responsiveness provides a clue and should be assessed if there is concern. [ABSTRACT FROM AUTHOR]

ABSTRACT. A postal questionnaire, completed by parents, was used to study the prevalence of respiratory symptoms in 250 children with atopic dermatitis who had attended pediatric dermatology clinics in London within the past 5 years. A response rate of 84% was achieved. Each child had a control matched for age and sex, whose parents filled in an identical questionnaire. The prevalence of wheezing was 76% in the atopic dermatitis group and 12% in the control group. Of the children with atopic dermatitis who wheezed, 87% had been given a diagnosis of asthma by a doctor, compared with 40% of the control children who wheezed. Overall, 68% of the children with atopic dermatitis had been given a diagnosis of asthma by a doctor. This prevalence of respiratory symptoms and of diagnosed asthma is substantially higher than has been shown in previous studies. As the test population consisted of children who had been referred to a tertiary center for management of their skin disease, this higher prevalence may partially reflect the increased severity of atopic dermatitis in the study group, as well as the heightened awareness of the association between these two diseases by their parents and physicians. [ABSTRACT FROM AUTHOR]

British guidelines on asthma recommend nurse delivered structured discharges for all children with asthma. This study carried out a postal and telephone survey to investigate the provision of this service. Twenty out of 34 (59%) hospitals in the Northern and Yorkshire regions do not have a recognised paediatric respiratory nurse post to facilitate this aspect of care. [ABSTRACT FROM AUTHOR]