A Study of 456 cases of death from asthma (1993-1997) from an investigation by the Tokyo Medical Examiner’s Office

Abstract

Mortality from asthma in Japan still remains at a higher level than in Europe and America and how to decrease that mortality rate is an important issue. For the prevention of death from asthma, it is essential to study the risk factors. However, there has been almost no such study performed in Japan and, for this reason, we performed the present study to elucidate the background of the recent cases of death from asthma. This study was performed on cases of death from asthma at the Tokyo Medical Examiner’s Office over a period of 5 years (1993-1997). There were 456 cases under study, with the age at death ranging from 4 to 96 years (average age 58.5 years). The male to female ratio was 1.8:1 and there was a tendency for a marked increase in the number of cases of death from asthma in women aged 60 years and older. The annual number of deaths was lowest in 1997, being 67 cases. The monthly number of deaths was higher in December and February and was lower in the months of June, July and September. Among the cases investigated, 60.2% died within 3 h after the onset of an asthmatic attack. In the cases of patients living alone, the chance of receiving emergency medical care was significantly lower compared with cases where patients lived with other people. Of the cases of death from asthma, 36.6% of patients were in the habit of drinking and 27.7% smoked. In an investigation of the 247 deaths that occurred during the 3 year period from 1995 to 1997, there were 140 cases (56.7%) for which emergency medical care was offered to treat the asthmatic attack. In 126 cases (90.0%), cardiopulmonary arrest was observed on arrival at hospital. Of these cases, a heart beat was restored in 27 patients (21.4%). In 133 of 456 deaths (29.2%), patients had used a metered dose inhaler (MDI). Among these cases, 80 patients (60.2%) seemed to have been using a MDI up to the time immediately before death. Those living alone have a significantly lower likelihood of receiving emergency medical care immediately before death compared with those living with other people. The cases of acute death within 3 h after the onset of the asthma attack accounted for 60.2% of all cases and this seems to be important for future studies of the medical care of deaths due to asthma.