Asthma deaths outside the hospital in an urban community from 2004 to 2008

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BackgroundSeveral studies have been performed reviewing medical examiner's autopsy reports of asthma deaths. None, to our knowledge, have focused on the characteristics of asthma deaths in the urban community alone. ObjectiveTo characterize factors related to asthma deaths occurring outside the hospital setting in an urban community. MethodsWe reviewed the medical records of 22 patients who died outside the hospital of asthma and underwent autopsy performed by the Milwaukee County medical examiner from 2004 to 2008. ResultsThe mean age of the patients was 32 years (range, 12–71 years), 11 patients were male, and 14 patients (64%) were African American. Seventeen patients (77%) died during the night or shortly on awakening. Twelve patients (55%) died in June, July, or August. A history of illicit drug, alcohol, or tobacco use was discovered in 13 patients (59%). Toxicologic test results for drugs of abuse were positive in 4 patients (18%). Twenty patients were using or overusing a short-acting β-agonist, 1 patient was taking omalizumab, and none were taking long-acting β-agonists alone. Two patients were taking no medications. Asthma severity and medication adherence were not consistently reported. Lung pathologic testing revealed eosinophils in 18 patients and a lack of neutrophils in every case. ConclusionIn this small and limited series of asthma deaths occurring in an urban setting outside the hospital, individuals were more likely to be African Americans, with deaths occurring more frequently at night, during the summer months, and in those with substance abuse and not taking anti-inflammatory asthma medications.