Deaths with asthma in France, 2000-2005: a multiple-cause analysis

Asthma Mortality and Hospitalizations in Mexico from 2010 to 2018: Retrospective Epidemiologic Profile

Acute respiratory infections have been established as the principal cause of disease in the Mexican population from 2000 to 2018; however, even when these diseases may aggravate asthma, there is a lack of epidemiologic evidence on the health outcomes when both conditions coexist. Learning about the asthma hospitalizations trends will help us identify monthly variation of hospitalizations, vulnerable groups, needed services, and improvements in therapeutics and prevention. This study aims to analyze the variation in asthma hospitalizations and mortality during the 2010–2018 period in Mexico. Data were obtained from the General Board of Health Information (DGIS) Open Access datasets, which were analyzed taking hospital discharges and hospital deaths recorded from 2010 to 2018 from all public hospitals nationwide. The binomial logistic regression analyses were performed to determine the association between patient ages, hospitalization month, and mortality. The death rate from asthma in Mexico decreased between 2010 and 2018. Still, the hospital mortality rate shows recent improvement; however, prognosis of hospitalized patients depends on their age, accurate diagnosis, length of hospital stay and occurrence of nosocomial infection.

Use of population data for assessing trends in work-related asthma mortality

PURPOSE OF REVIEW

Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma.

RECENT FINDINGS

A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data.

SUMMARY

Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.

[Asthma exacerbations in adults: Preventing and treat]

Exacerbations of asthma are still responsible for 900 deaths per year in France, most of which are considered preventable. They have a major impact on the quality of life of patients and are responsible for a large part of the socio-economic cost of asthma in France. Exacerbations of asthma can be partly prevented by inhaled corticosteroid treatment as controller therapy, at a dose adapted to the level of control of symptoms and the management of aggravating factors. Every patient should benefit from a written action plan that allows them to start oral corticosteroid therapy as soon as possible during an exacerbation. The treatment combines short-acting bronchodilators with systemic corticosteroids. Systemic antibiotic therapy has no place in the treatment of exacerbations. The patient must be seen early in the course of an exacerbation of asthma to review all of his follow-up.

Fatal and near-fatal thunderstorm asthma epidemic in a desert country

BACKGROUND:

Reports of thunderstorm asthma in the Middle East are few. This study is the first to report on cases of near-fatal and fatal thunderstorm asthma in Kuwait on December 1, 2016.

METHODS:

We conducted a chart review and interview with adult patients admitted to Mubarak Al-Kabir Hospital with near-fatal asthma, defined as an exacerbation requiring intubation and mechanical ventilation or hypercapnia with a PaCO₂≥6 kPa. Information, including patient age, gender, occupation, asthma history, medication usage, and clinical outcome, was collected. For fatal asthma cases, patients' data were collected from the Forensic Department at the Kuwait Ministry of Interior.

RESULTS:

A total of 17 patients were admitted with near-fatal asthma. Fifteen patients (93.8%) had a prior history of asthma, with an average duration of 9 years. Five patients (33.3%) reported receiving a corticosteroid inhaler from their physician. Fifteen patients (93.8%) reported relying on a short-acting β2-agonist alone to manage their asthma. Eleven patients (68.8%) reported being outdoors during the storm. Eleven patients were diagnosed with fatal asthma.

CONCLUSION:

The study is the first to report on a thunderstorm-associated asthma epidemic in Kuwait and emphasizes the potential dangers associated with this entity.

Higher mortality of adults with asthma: A 15-year follow-up of a population-based cohort

BACKGROUND

Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) are associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults with and without asthma.

METHODS

We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models.

RESULTS

During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 nonasthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P = .011) as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18-34.2, P < .001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25-4.42, P = .008). Among asthmatics, smoking was associated with increased all-cause mortality, and self-reported AR/AC was associated with decreased mortality. Among nonasthmatics, smoking, and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk.

CONCLUSIONS

Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms, and cardiovascular diseases. Smoking cessation is important for reduction in total mortality in both asthmatic and nonasthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.

A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up

Background and objective: Asthma is a major public health concern. The aim of this study was to characterize a large population-based cohort of adults with asthma, and to study factors associated with all-cause mortality and non-participation in a long-term follow-up. Design: Random and stratified samples from five population-based cohorts were clinically examined during 1986-2001, and all subjects with asthma were included in the study (n = 2055, age 19-72 years, 55% women). Independent associations between different risk factors and (i) mortality and (ii) non-participation in a clinical follow-up in 2012-2014 were estimated. Results: In 1986-2001, 95% reported any wheeze and/or attacks of shortness of breath in the past 12 months, and/or asthma medication use. Over the up to 28 years of follow-up time, the cumulative mortality was 22.7%. Male gender, current smoking, and lower forced expiratory volume in 1 sec of predicted (FEV₁% of predicted) were independent risk factors for mortality, while obesity was associated with non-participation in the follow-up. Older ages, ischemic heart disease, and low socioeconomic status were associated with both mortality and non-participation. Conclusions: The risk factors associated with mortality in this adult population-based asthma cohort were similar to those commonly identified in general population samples, i.e. male gender, current smoking, and lower FEV₁% of predicted, while obesity was associated with non-participation in a long-term follow-up. Ischemic heart disease, low socioeconomic status, and older ages were associated with both mortality and non-participation.

Fatal asthma; is it still an epidemic?

BACKGROUND

Asthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors.

METHODS

A web search including key words related to fatal asthma in Italy between 2013 and 2015 has been performed. Concerning the cases that occurred in Veneto, subjects' clinical records have been evaluated and details about concomitant weather conditions, pollutants and pollen count have been collected.

RESULTS

Twenty-three cases of asthma deaths were found in Italy; 16 of them (69%) occurred in the Veneto Region. A prevalence of male and young age was observed. Most of patients were atopic, died in the night-time hours and during the weekends. The possible risk factors identified were the sensitization to alternaria, previous near fatal asthma attacks and the incorrect treatment of the disease. Weather condition did not appear to be related to the fatal exacerbations, whereas among the pollutants only ozone was detected over the accepted limits. Smoking habits, possible drug abuse and concomitant complementary therapies might be regarded as further risk factors.

DISCUSSION

Although not free from potential biases, our web search and further investigations highlight an increasing asthma mortality trend, similarly to what other observatories report. The analysis of available clinical data suggests that the lack of treatment more than a severe asthma phenotype characterizes the fatal events.

CONCLUSIONS

Asthma mortality still represents a critical issue in the management of the disease, particularly in youngsters. Once more the inadequate treatment and the lack of adherence seem to be not only related to the uncontrolled asthma but also to asthma mortality.

A nationwide survey of the severity, comorbidity, and mortality of hospitalized patients with asthma in Taiwan

OBJECTIVE

To clarify the epidemiology of asthma admission in a nationwide survey, we analyze the characteristics of hospitalized patients in Taiwan.

METHODS

Data regarding asthma-associated hospitalizations were obtained from the National Health Insurance Research Database of Taiwan from January 2001 to December 2002. Patient characteristics in terms of severity, mortality, and cost were stratified by age, gender, and presence of comorbidities.

RESULTS

A total of 59,983 hospitalizations with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 493.xx and asthma-related treatment were included in the current analysis. When stratified by age, the number and duration of hospitalizations were distributed in J-shape distribution, with the nadir located in the range of 8-18 years of age. The severity of asthma was found to increase with age (p < 0.001) and was more severe in men compared with women (p < 0.001). The severity of in-hospital patients was significantly greater in subjects with underlying respiratory disease compared to patients with other comorbidities, such as cardiovascular disease and infectious disease. The mortality rates of all hospitalized asthma patients and pediatric hospitalized asthma patients were 0.77% and 0.02%, respectively. The risk factor for mortality of asthma was older age and male gender in multiple regression.

CONCLUSION

The severity of asthma increased after 18 years of age. Increased comorbidities in elderly patients might contribute to asthma severity. The mortality rate was low in pediatric patients and significantly increased in males and the elderly. The above findings suggest that additional effort is required in the treatment of elderly and male asthmatic patients.

Asthma and lung cancer risk: a systematic investigation by the International Lung Cancer Consortium

Asthma has been hypothesized to be associated with lung cancer (LC) risk. We conducted a pooled analysis of 16 studies in the International Lung Cancer Consortium (ILCCO) to quantitatively assess this association and compared the results with 36 previously published studies. In total, information from 585 444 individuals was used. Study-specific measures were combined using random effects models. A meta-regression and subgroup meta-analyses were performed to identify sources of heterogeneity. The overall LC relative risk (RR) associated with asthma was 1.28 [95% confidence intervals (CIs) = 1.16-1.41] but with large heterogeneity (I(2) = 73%, P < 0.001) between studies. Among ILCCO studies, an increased risk was found for squamous cell (RR = 1.69, 95%, CI = 1.26-2.26) and for small-cell carcinoma (RR = 1.71, 95% CI = 0.99-2.95) but was weaker for adenocarcinoma (RR = 1.09, 95% CI = 0.88-1.36). The increased LC risk was strongest in the 2 years after asthma diagnosis (RR = 2.13, 95% CI = 1.09-4.17) but subjects diagnosed with asthma over 10 years prior had no or little increased LC risk (RR = 1.10, 95% CI = 0.94-1.30). Because the increased incidence of LC was chiefly observed in small cell and squamous cell lung carcinomas, primarily within 2 years of asthma diagnosis and because the association was weak among never smokers, we conclude that the association may not reflect a causal effect of asthma on the risk of LC.

Asthma mortality in Puerto Rico: 1980-2007

BACKGROUND

Asthma is a highly prevalent chronic disease. Prevalence and mortality are particularly high in Puerto Ricans living in the United States as compared with other populations.

OBJECTIVE

To determine asthma mortality rates in Puerto Rico (1980-2007) and to assess the sociodemographic variables that may be associated with these rates.

METHODS

Data were obtained from the Vital Statistics Office at the Puerto Rico Department of Health. Crude mortality rates (CMRs) and their 95% confidence intervals (95% CIs) were used to evaluate differences between age groups and across years. Mortality risk ratios (RRs) by sociodemographic variables were estimated using generalized lineal models with a Poisson link function to identify at-risk groups.

RESULTS

During the study period, there were 4232 deaths recorded with asthma as the cause of death. From 1980 to 1998, annual asthma mortality rates fluctuated between 3.32 and 6.56 deaths per 100,000 (mean 4.77), followed by a decline after implementation of the ICD-10 for reporting cause of death in 1999. Between 1999 and 2007, the mean asthma death rate declined to 3.01 (4.89 in 1999 to 2.02 in 2007). Overall, asthma mortality rates were between 1.77 and 4.0 times higher in Puerto Rico than in the United States. Throughout the whole study period, mortality rates were higher in older age groups. In addition, the adjusted regression model for asthma deaths showed that persons divorced or widowed, and persons with only elementary education had significantly higher risk of asthma mortality than their counterparts.

CONCLUSION

Asthma death rates were higher in Puerto Rico than in the United States general population. Although asthma mortality in Puerto Rico declined, rates continued to be significantly higher than those recorded in the United States. There was a progressive decline in asthma mortality rates after 1999 that may be explained by changes in reporting classification, increased use of corticosteroids, and improved asthma awareness. After controlling for possible confounding variables, age and elementary education were found to increase the risk of mortality due to asthma among Puerto Ricans.

[Asthma in France: a review of descriptive epidemiological data]

This article presents a review of the most recent data on descriptive epidemiology of asthma in France. The latest national surveys show a cumulative prevalence of asthma of more than 10% in children aged 10 years or more and a prevalence of current asthma from 6 to 7% in adults. In 2006, 1038 deaths from asthma were registered (64 deaths among people aged less than 45 years). After the peak observed in the 1980s, mortality from asthma has decreased. The decrease is also observed among children and young adults. According to data from the French discharge database (PMSI), there were 54 130 admissions for asthma (asthma as the principal diagnosis) in 2007. Between 1998 and 2007, the annual rate of admission for asthma decreased. However, no decreasing trend was observed in children and, in adults, admission rates seem to have been stable since 2004. The increase in the rate of admission for acute respiratory failure (ARF) associated with asthma (ARF as the principal diagnosis and asthma as an associated diagnosis) does not compensate for the decrease in the admission rate for asthma that was observed in adults. Data on emergency department visits show evidence of strong seasonal variations in asthma exacerbations.