Introduction

Respiratory causes of sudden and unexpected death in the young are often due to acute obstruction of the airway by an impacted foreign body (as discussed in Chapter 2) or to critical narrowing by an intrinsic lesion such as an inflamed epiglottis. Other major causes of sudden respiratory death are asthma and infective conditions, such as acute bronchopneumonia. These disorders are listed in Table 7.1.

In two studies of sudden death in children and young adults, respiratory disease was a cause of death in 10 of 31 cases (32%) and in 12 of 78 cases (15%). Molander found four cases of bronchopneumonia, three cases of asthma, and three cases of acute epiglottitis, while Siboni & Simonsen found a greater number of cases of fulminant tracheobronchitis (five of the 12 cases of fatal respiratory disease), with four cases of acute epiglottitis, two of asthma, and a final case in which death was attributed to acute tonsillitis. Thus, acute respiratory disease may account for a significant number of cases of sudden natural death in children and young adults.

The proportion of cases of sudden childhood death due to respiratory obstruction has, however, changed in recent years. For example, there has been virtual elimination of deaths due to acute epiglottitis in communities where immunization programs for Hemophilus influenzae have been instituted, and a significant reduction in the number of deaths due to foreign-body inhalation when campaigns aimed at increasing parental awareness of the dangers of choking have been developed.