Risk factors for death from asthma

doi:10.1016/S1081-1206(10)62832-3

Annals of Allergy, Asthma & Immunology

Volume 83, Issue 5, November 1999, Pages 362-368

https://doi.org/10.1016/S1081-1206(10)62832-3 Get rights and content

Background

Asthma mortality rates have increased in Canada and worldwide. Within Canada, the highest rates were seen in the prairie provinces.

Objective

The objective was to determine risk factors for fatal asthma by comparing those who died of an acute exacerbation with those who attended an emergency department for treatment of asthma.

Methods

The case-control study included all deaths from asthma among those aged 5 to 50 years in Alberta, Saskatchewan and Manitoba from November, 1992 through October, 1995 (cases). The 35 fatalities were matched to 209 controls by age, gender, time of the index event and residence.

Results

Cases were more likely than controls to have had severe asthma, an unscheduled physician visit in the past year, a past hospitalization for asthma, and to have been intubated. Both groups reported frequent, regular asthma symptoms. Beta-agonist bronchodilator use was more common among cases, as was use in excess of prescribed amounts. Use of inhaled steroids did not differ between groups. Prior to the index event controls were more likely to report a cold or flu (OR = 0.27; 95% CI: 0.10 to 0.72) and that medications were "not working" (OR = 0.30; 95% CI: 0.12 to 0.71). Cases were more often sad and depressed (OR = 2.88; 95% CI: 1.03 to 8.05). Time between onset/recognition of symptoms and the event was significantly shorter for cases than controls.

Conclusions

Both groups tolerated high levels of regular symptoms, suggesting poor management. Opportunities for intervention existed for both groups near the time of the event. The short time between recognition of symptoms and death suggests patients at increased risk should monitor their condition closely and take action in response to predetermined criteria.

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Ecologic analysis of asthma-related events and dispensing of inhaled corticosteroid- and salmeterol-containing products
2008, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
Studies suggest higher asthma mortality rates among minority populations, including African American populations, 22–24 and among individuals with lower socioeconomic status. 24,25 Epidemiologic studies have identified multiple behavioral risk factors for asthma mortality, including poor compliance to asthma medications, 20,26,27 overuse of reliever medication without ICSs, 26,27 missed hospital or general practitioner appointments, 20,28 poor inhaler technique, psychosis diagnosis or treatment, alcohol abuse, family problems, and recent history of learning difficulties. 28–30 It is possible that a rare phenotype of patients exists who experience an increased risk of asthma-related morbidity and mortality when exposed to salmeterol or LABA.
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To examine the relationship between number of prescriptions dispensed of salmeterol-containing products and inhaled corticosteroid (ICS)-containing products and the rates of asthma-related hospitalizations and mortality in the United States.
In this ecologic study, annual age-adjusted rates of asthma-related hospitalization and asthma-related mortality from US population-based sources were graphed alongside annual number of prescriptions dispensed of salmeterol- and ICS-containing products by year from 1991 to 2004. We computed the Spearman rank correlations between number of prescriptions dispensed and serious events (asthma-related hospitalization rate, number of hospitalizations, asthma-related mortality rate, and number of asthma deaths).
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View all citing articles on Scopus

: The study was funded by the Laboratory Centres for Disease Control, Health Canada.

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ORIGINAL ARTICLESRisk factors for death from asthma

Background

Objective

Methods

Results

Conclusions

Chest

Am J Med

J Allergy Clin Immunol

Chest

Worldwide trends in asthma mortality

Bull Int Union Tuberc Lung Dis

Increased rates of illness and death from asthma in Canada

Can Med Assoc J

Circumstances surrounding deaths from asthma in Cook County (Chicago) Illinois

Allergy Proc

Health service accessibility and deaths from asthma

Int J Epidemiol

The use of β-agonists and the risk of death and near death from asthma

N Engl J Med

Near-fatal asthma in South Australia: descriptive features and medication use

Aust NZ J Med

Comparative morphology of the airways in asthma and chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Trends in rates of admission to hospital and death from asthma among children and young adults in Canada during the 1980s

Can Med Assoc J

Accuracy of certification of deaths due to asthma: a national study

Am J Epidemiol

Age specific trends in asthma mortality in England and Wales, 1983–95: results of an observational study

Br Med J

ORIGINAL ARTICLES
Risk factors for death from asthma