Epidemiology of Asthma Mortality

Abstract

The epidemiology of asthma mortality has been controversial since Osler stated in the Principles and Practice of Medicine,published in 1901, that the “the asthmatic pants into old age” [1]. Certainly asthma deaths were rare in the first half of this century, although since this time, the patterns of asthma mortality have become considerably more complex. There have been epidemics of asthma deaths in six Western countries in the 1960s, and again in New Zealand in the 1970s. Another feature observed in many countries has been a more gradual increase in asthma mortality, which commenced in the 1940s and has been particularly marked in the 1970s and 1980s. During the 1990s, mortality has declined in some, but not in other countries. In this chapter, we commence by briefly considering issues relevant to the interpretation of long-term time trends in asthma mortality. We then discuss the international trends in asthma mortality throughout the 20th century, focusing primarily on the possible causes for the mortality epidemics and the gradual rise in asthma mortality which has occurred over recent decades. Finally, we review markers of an increased risk of asthma mortality, the characteristics of patients experiencing a fatal or near fatal attack of asthma, and factors that can provoke such episodes.