The tragic death from asthma of a 10-year-old boy, William Gray, is a clear signal once again that doctors, nurses, and other healthcare professionals at all levels in the UK must take childhood asthma seriously. According to the coroner’s Regulation 28 report to prevent future deaths,1 William had a life-threatening asthma attack in October 2020. He was sent home by the accident and emergency (A&E) doctors only 4 hours after being brought in by the paramedics who had actually administered adrenaline on the way in. Maintenance inhaled corticosteroids (ICS) were not included on discharge from A&E. His GP then prescribed four courses of oral prednisolone for acute asthma attacks in the subsequent 7 months before he died on 29 May 2021. He was seen by a nurse practitioner on 25 May at the request of the GP following the fourth course of oral corticosteroids, but there was no escalation of his care or onward referral. He died 4 days later. The coroner concluded ‘that [the courses of oral corticosteroids] were insufficient to effectively manage obviously poorly controlled asthma in a picture of vastly excessive [short-acting beta-2 agonist (SABA) bronchodilator] reliever inhaler prescriptions and the absence ongoing of preventer medication.’1 This coroner’s Regulation 28 report to prevent further deaths from asthma, published in December 2023, requires very urgent national action; it cannot be allowed to be forgotten, as have four previous Regulation 28s in which the lead author was expert witness. We are extremely saddened, and angry, that so many children continue to die from asthma in the UK and that action is not taken despite the same issues arising in the previous Regulation …
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