Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Is Global Asthma Mortality on the Decline?

Lancet; ePub 2017 Aug 7; Ebmeier, et al

Publish date:

The trend in global asthma mortality may have stalled since the late 1980s, with no appreciable difference in global asthma mortality from 2006 to 2012. This according to a study that analyzed data from the World Health Organization (WHO) Mortality Database for 46 countries from 1993 to 2012 to determine trends in international asthma mortality. Age-standardized country-specific asthma mortality rates in the 5-34 year age group were collated. Researchers found:

  • 36 of the 46 countries were high-income countries, and 10 were middle-income countries.
  • The estimate of the global asthma mortality rate was 0.44 deaths per 100,000 persons in 1993 and 0.19 deaths per 100,000 persons in 2006.
  • Despite further reductions in some countries and regions of the world, there was no appreciable change in global asthma mortality rates from 2006 through 2012.

Citation:

Ebmeier S, Thayabaran D, Braithwaite I, Bénamara C, Weatherall M, Beasley R. Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993-2012). [Published online ahead of print August 7, 2017]. Lancet. doi:10.1016/S0140-6736(17)31448-4.

Commentary:

Asthma causes a great deal of both morbidity and mortality. Approximately 1 in 12 people in the US have asthma, an increase of about 20% in the last 10 years. In addition, half of those who have asthma have had an asthma exacerbation over the previous year. Half of all children with asthma, and a third of adults, missed school or work due to their asthma. While we do not usually think of asthma as a disease associated with mortality, there were 3,447 deaths from asthma (9 deaths per day) in the US in 2007.1 The decrease in asthma in the 1990s is largely attributed to the recognition that asthma is an inflammatory chronic disease and that inhaled steroids are an essential part of ongoing management.2 This study shows that the decrease in asthma mortality through the 1990s to mid-2000s has plateaued. This leveling of improvement may be due to inadequate treatment of individuals with mild-to-moderate persistent asthma, as patients with mild-to-moderate asthma constitute a significant group of patients that die from asthma exacerbations. One study in Canada suggested that markers of increased asthma mortality risk included more than 1 hospital admission with asthma, 3 emergency department visits, or 5 physician visits.3 On a population level, it is important to identify individuals who are at risk for severe exacerbations and provide the support needed and ensure that those individuals receive appropriate treatment. On the individual practice level, increased hospital admission, ER visits, or office visits should be a signal to us to ensure that the patient is prescribed and taking an inhaled steroid. —Neil Skolnik, MD

  1. Asthma in the US Center for Disease Control and Prevention—Vital Signs. https://www.cdc.gov/vitalsigns/asthma/index.html. Accessed August 15, 2017.
  2. Jenkins C. Lancet. Eliminating asthma deaths: have we stalled? [Published online ahead of print August 7, 2017]. doi:10.1016/ S0140-6736(17)31587-8.
  3. To T, Zhu J, Williams DP, et al. Frequency of health service use in the year prior to asthma death. J Asthma. 2016;505–509.

This Week's Must Reads