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.