Focus area: Physicians
Asthma mortality: are we at a dead point?
In these decades there has been a marked reduction in asthma mortality rates, but now it seems there is no improvement anymore. What are we missing?
The asthma mortality rate, according to WHO Mortality Database from 1993-2012 in those aged between 5 and 34 years, seems to be reduced by 57%, from 0,44 per 100.000 in 1993 to 0,19 per 100.000 in 2006. Some important factors have been the better use of SABA (Short-acting Beta2-agonists), the treatment of asthma as chronic disease and the widespread availability of inhaled corticosteroids.
In the last years there has been a plateau… There are some “confounding” factors, but the data should question us: What can cause death in asthmatic patients? Is there something we could do?
There are comorbidity, cigarette smoking, psychosocial dysfunction and poor health literacy, barriers that affect a little group of asthmatic patients, people that can’t be treated by “standard” method, but that need dedicated care. Often it isn’t the “severe asthma” that kills them, but the poorly controlled mild-to-moderate asthma. Preventable deaths.
We almost always refer to “precision medicine” in terms of targeting medications to specific feature of a disease, but less often we focus on the psychosocial aspects of targeting treatment; we are not always able to understand and manage that behavioural factors that underlie poorly controlled, near-fatal and fatal asthma. Red flags for high risk asthma? More than one hospital admission with asthma, 3 emergency department visits, or 5 physician visits.
The asthma mortality today is no longer the story of young people with under-recognised or under-treated asthma, but of older adults, with more comorbidities and worse lung function. We have few data and so we don't know how act at the moment. Reducing asthma mortality could be a different task from reducing morbidity, from the achievement of “controlled” asthma.
Eliminating asthma deaths is a big goal and it needs equally big efforts.
Jenkins C. Eliminating asthma deaths: have we stalled? The Lancet, August 7, 2017.