Asthma Deaths Research Articles

Temporal trends and future projections of incidence rate and mortality for asthma in China: an analysis of the Global Burden of Disease Study 2021

BackgroundAsthma poses a significant public health burden in China, affecting millions with substantial incidence and mortality. Understanding the trends and future projections of asthma incidence and mortality is crucial for healthcare planning.MethodsWe analyzed asthma incidence and mortality data sourced from the Global Burden of Disease (GBD) 2021 study from 1990 to 2021, calculated the age-standardized incidence and mortality rates (ASIR and ASMR) and the estimated annual percentage change (EAPC), meanwhile, employed Joinpoint regression model to assess the trends. The age-period-cohort model was applied to estimate the effects of the age, period, and cohort on the incidence and mortality. Finally, future asthma trends for the next 25 years were predicted utilizing the Bayesian age-period-cohort (BAPC) model.ResultsOver the past three decades, the incidence rate declined in waves while the mortality declined steadily. The ASIR of asthma decreased from 524.81 to 364.17 and the ASMR declined from 5.82 to 1.47. ASIR and ASMR are consistently higher in males than females during this period. The effect attributable to age on incidence was higher for the younger age group while the mortality was higher for older. The period ratio rate of incidence and mortality declined with the calendar year, and the corrections between birth cohort and the risk of incidence and mortality were negative. Our projections indicate that the ASIR and ASMR will continue to decrease by 2046, with expected rates of 330 and 0.69, respectively. Instead, the absolute number of asthma incidence cases and deaths may increase to approximately 4.5 million and 80,000, respectively.ConclusionAlthough asthma incidence rates and mortality have generally declined in China, the burden remains significant, especially among vulnerable groups, with higher rates in males. Continuous monitoring and age-targeted interventions are essential. Future healthcare strategies must address the aging population to manage the projected increase in asthma cases and deaths.

Socioeconomic status has direct impact on asthma control: Turkish adult asthma registry.

Asthma is one of the most common causes of chronic respiratory disease, and countries with low socioeconomic status have both a high prevalence of asthma and asthma-related death. In this study, we aimed to determine socioeconomic levels of asthmatic patients according to a national database and investigate the effects of social markers on disease control in our region. This is an analysis of data from 2053 adult asthma patients from a multicentre chart study in Turkey. Socioeconomic status (SES) data were collected from questionnaires and this form was sent to the patients via e-mail. Parameters related to social status and poor disease control were analyzed. Illiteracy (OR:2.687 [95% CI: 1.235-5.848]; p=0.013) and lower household income (OR:1,76 [95% CI: 1.002-3.09]; p=0.049) were found as independent risk factors for hospitalization in the multivariate logistic regression analysis. Therewithal, being aged between 40 and 60 (OR: 1.435 [95% CI: 1.074-1.917]; p=0.015), illiteracy (OR: 2.188 [95% CI: 1.262-3.795]; p=0.005) and being employed (OR: 1.466 [95% CI: 1.085-1.847]; p=0.011) were considered as independent risk factors for systemic corticosteroid use at least 3days within last 1year. As a result of our national database, education level, household income and working status briefly socioeconomic status have impacts on asthma control. Identification of social markers in asthma and better recognition of risk factors based on the population gives us clues to provide better asthma control in the future.

Temporal trends in the prevalence of GP registrars’ long-term paediatric asthma control medications prescription

Asthma is one of the most common chronic illnesses affecting children. Long-term asthma control medications (LTACMs) are an important aspect of asthma management, with under-prescription associated with poor asthma control and increased asthma deaths. This study aimed to document temporal trends in the prescribing of LTACMs for paediatric patients for asthma-related presentations to Australian general practice registrars (trainees). Longitudinal analyses of data from 2010 to 2022 from the Registrars Clinical Encounters in Training study were undertaken. Proportions of paediatric presentations where LTACMs were prescribed were calculated, and temporal trends analysed and graphed. There was no change over time in registrar prescribing of LTACMs for paediatric asthma, although temporal changes were seen in the types of LTACMs prescribed. The lack of temporal increase in overall LTACMs prescription, despite evidence showing their importance in preventing asthma morbidity and mortality, has significant educational, clinical, and policy implications.

Deaths from asthma: a series of cases and their presentations, and the impact on local and global health

Abstract Introduction/Objective Asthma is a lung disease usually characterized by chronic inflammation that affects at least 300 million people globally at all life stages. Asthma is defined by respiratory symptoms such as coughing, wheezing, shortness of breath, and chest tightness with expiratory airflow limitation.The prevalence of asthma is increasing worldwide. Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries. Severe disease can result in reduced quality of life or even premature death. Epidemiologic studies are being utilized to compare international incidences of asthma between populations so that etiologic mechanisms involved in the development of asthma can be discovered through research. Asthma prevalence studies require large numbers and high response rates amongst a random population to establish prevalence and severity with reasonable precision. Despite advances in treatments, guidelines, and preventable factors, deaths from asthma account for 250,000 premature deaths each year. Pathology has a key role in asthma identification through examination endobronchial biopsies and whole lung postmortem examination Methods/Case Report We present a series of asthma deaths with variable clinical presentations and histopathologic findings. The postmortem gross and histologic findings highlight the varying severities that asthma can have on the lungs. Knowledge of the clinical symptom presentations, identification of gross findings, appropriate sampling of lung tissue, identification of microscopic acute and chronic features help identify asthma related changes. Understanding common lifestyle, environmental, genetic, and medical care factors that serve as asthma triggers and their role in the onset or continuation of an acute exacerbation will allow for accurate determination of cause, contributing cause, and manner of death. This information, listed on the death certificate, is what helps correlate asthma prevalence with mortality allowing for appropriate allocation of funds for research, prevention and treatment. Results (if a Case Study enter NA) EP abstract Conclusion Outlined are the impacts that asthma can have on individuals, communities, and health systems globally but also ways to identify when death may be or is likely the result of asthma. While asthma cannot be cured, measuring the prevalence of disease and accurately determining asthma as the cause or contributing cause of death can help raise awareness and mitigate the consequences of severe disease.

Identification of regional and sex differences in asthma mortality trends in Spanish Autonomous Communities (1980–2022)

Objective Despite global declines in asthma mortality, regional variations and sex disparities persist. This study investigates asthma mortality trends in Spanish Autonomous Communities (ACs) from 1980 to 2022, analyzing data by sex. Methods Data on asthma deaths and population were obtained from the National Institute of Statistics for the study period. Age-standardized mortality rates (ASMRs) were calculated, and joinpoint regression models were applied to identify trends. Results Overall, 44,728 asthma deaths occurred, with a steeper decline observed in men (−3.5% per year) compared to women (−0.7% per year). The female-to-male mortality ratio climbed from 0.7 in 1980 to 5.4 in 2016. Both sexes exhibited a significant decrease in ASMRs, with a more substantial decline in males (−6.3%). While all ACs showed a significant decrease in male ASMRs, female trends varied, with significant decreases in 13 ACs and stable trends elsewhere. Joinpoint analysis revealed diverse regional patterns for both sexes, with some ACs experiencing steady declines and others exhibiting periods of slower decline or even stabilization. Conclusion This study identified concerning regional and sex disparities in Spanish ACs’ asthma mortality (1980–2022). While male rates declined significantly across all regions, female rates showed variation, with even increases in some ACs. Targeted interventions addressing these disparities and their underlying causes (healthcare access, management practices, etc.) are crucial.

The Status of Asthma in the United States.

Asthma imposes a substantial health and economic burden on patients and their families and on the health care system. An assessment of the status of asthma in the US may lead to effective strategies to improve health and quality of life among people with asthma. The objective of our study was to assess the historical trends and current state of asthma illness and death among children and adults in the US. We assessed asthma-related emergency department visits and hospitalizations among children and adults by using data from the 2010-2021 National Health Interview Survey (NHIS), the 2010-2020 Nationwide Emergency Department Sample (NEDS), the National (Nationwide) Inpatient Sample (NIS), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ). Asthma death rates were calculated by using 2010-2021 National Vital Statistics System data. Asthma prevalence increased significantly among adults from 2013 through 2021 (P = .04 for the annual percentage change [APC] slope) and decreased among children from 2010 through 2021 (P values for slopes: 2010-2017, P = .03; 2017-2021, P = .03). Prevalence of current asthma was higher among non-Hispanic Black people (children, 12.5%; adjusted prevalence ratio [APR] = 2.19; 95% CI, 1.68-2.84 and adults, 10.6%; APR = 1.25; 95% CI, 1.09-1.43) compared with non-Hispanic White people (children, 5.7%; adults, 8.2%). Prevalence of asthma attacks and use of asthma-related health care declined among adults and children. Asthma prevalence and asthma-related emergency department visits, hospitalization, and death rates differed by select characteristics. Although asthma attacks, ED visits, hospitalizations, and deaths have declined since 2010 among all ages, current asthma prevalence declined only among children, and significant disparities in health and health care use still exist.

Effect of the COVID-19 Pandemic on Respiratory Diseases and Their Economic Impacts.

COVID-19 is an airborne respiratory disease that mainly affects the lungs. To date, COVID-19 has infected 580 million people with a mortality of approximately 7 million people worldwide. The emergence of COVID-19 has also affected the infectivity, diagnosis, and disease outcomes of existing diseases such as influenza, TB, and asthma in human populations. These are airborne respiratory diseases with symptoms and mode of transmission similar to those of COVID-19. It was speculated that the protracted nature of the COVID-19 pandemic coupled with vaccination could impact other respiratory diseases and mortality. In this study, we analyzed the impact of COVID-19 on flu, tuberculosis (TB), and asthma. Our analyses suggest that COVID-19 has a potential impact on the mortality of flu, TB, and asthma. These impacts vary across before the COVID-19 era, during the peak period of the pandemic, and after vaccinations/preventive measures were implemented, as well as across different regions of the world. Overall, the spread of flu generally reduced during the pandemic, resulting in a reduced expenditure on flu-related hospitalizations, although there were sporadic spikes at setting times. In contrast, TB deaths generally increased perhaps due to the disruption in access to TB services and reduction in resources. Asthma deaths, on the other hand, only marginally varied. Collectively, the emergence of COVID-19 added extra cost to the overall expenditure on some respiratory infectious diseases, while the cost for other infectious diseases was either reduced or somewhat unaffected.

Global burden of pediatric asthma and rhinitis - what we have recently learned from epidemiology.

To analyze and present recently published information on the factors that modify the burden of asthma and rhinitis in pediatric ages, such as ecological determinants; highlighting access and adherence to medications, exposure to pollutants and climate change. In addition to individual determinants such as obesity, protective & risk factors and comorbidities. Asthma and rhinitis continue to have a significant impact worldwide on the health of affected patients, primarily children. The burden of asthma is greatest in developing countries and vulnerable populations, resulting in increased morbidity, potentially preventable asthma deaths and socioeconomic consequences. A better understanding and representation of the burden of asthma and rhinitis in children can contribute to prevention strategies and improvements in the care of pediatric patients.

Global patterns of asthma burden related to environmental risk factors during 1990–2019: an age-period-cohort analysis for global burden of disease study 2019

BackgroundChange in asthma burden attributed to specific environmental risk factor has not been evaluated.ObjectiveWe aimed to explore the age, period, and cohort effects on asthma burden attributable to smoking and occupational asthmagens in different socio-demographic index (SDI) regions and the region and sex disparities.MethodsRisk factor-specific asthma deaths and disability-adjusted life years (DALYs) rates were extracted from Global Burden of Disease study 2019, estimated by standard Combined Cause of Death Model and DisMod-MR 2.1 modeling tool. Age-period-cohort analysis was conducted to decompose age, period, and cohort effects on asthma burden.ResultsSmoking- and occupational asthmagens-related asthma deaths and DALYs rates dropped by > 45% during 1990–2019. In 2019, Africa, South and Southeast Asia had higher asthma burden than other regions. Male had higher asthma burden than female. Among nearly all age groups, low-middle SDI region had the highest smoking-related asthma burden, and low SDI region had the highest occupational asthmagens-related asthma burden. Inverse “V” shaped trend was observed in the above regions with increasing age. For smoking-related asthma deaths and DALYs rates, the most significant improvement of period rate ratio (RR) occurred in high SDI region, decreased from 1.67 (1.61, 1.74) to 0.34 (0.33, 0.36) and 1.61 (1.57, 1.66) to 0.59 (0.57, 0.61), respectively, as well as the cohort effect on smoking-related asthma burden. For occupational asthmagens-related asthma deaths and DALYs rates, the most sharply decrease of period and cohort RR appeared in the high and high-middle SDI regions. Low SDI region showed least progress in period and cohort RR of smoking- and occupational asthmagens-linked asthma burden.ConclusionSmoking- and occupational asthmagens-related asthma burden sharply decreases, but region and sex disparities exist. Policy makers from low SDI region should reinforce tobacco control and prioritize workplace protection.

Recent increase in asthma mortality in Brazil: a warning sign for the public health system.

To provide an update on asthma mortality trends in Brazil and its regions between 2014 and 2021. This was a retrospective descriptive observational study based on asthma mortality data from the Brazilian National Ministry of Health Mortality Database for the 2014-2021 period. In the study period, there were 18,584 asthma deaths in Brazil, with an annual increase of 2.5%, corresponding to 0.03 deaths/100,000 population (95% CI, 0.01-0.04; p = 0.01). The northeastern region of the country had the highest prevalence of asthma deaths (1.50 deaths/100,000 population), and the southern region showed the greatest variation in the study period (44%). We observed a higher proportion of deaths among females and elderly patients, and when analyzing asthma deaths by place of occurrence, we observed that 28% of all deaths occurred at home. Asthma mortality remains high and shows an increasing trend for the first time in the past decades. This constitutes an important public health concern, given the treatable nature of the disease.

High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study.

Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 μm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

Secular trends of asthma mortality in China and the United States from 1990 to 2019.

Asthma imposes a large healthcare burden in China and the United States (US). However, the trends of asthma mortality and the relative risk factors have not been comparatively analyzed between the countries. The aim of this study was to compare the mortality and risk factors between China and the US. The deaths, and mortality rates of asthma in China and the US during 1990-2019 were obtained from the Global Burden of Disease Study 2019. The age-period-cohort model was used to estimate these mortality rates based on a log-linear scale with additive age, period, and cohort effects. The population attributable fractions of risk factors for asthma were estimated. In 1990-2019, the asthma mortality rate was higher in China than in the US. The crude and age-standardized asthma mortality rates trended downward in both China and the US from 1990 to 2019. The decline in mortality was more obvious in China. Mortality gap between the two countries was narrowing. A sex difference in asthma mortality was observed with higher mortality in males in China and females in the US. The age effects showed that mortality increased with age in adults older than 20 years, particularly in the elderly. Downward trends were generally observed in the period and cohort rate ratios in both countries, with China experiencing a more obvious decrease. Smoking and high body mass index (BMI) were the leading risk factors for asthma mortality in China and the US, respectively. Mortality attributable to occupational asthmagens and smoking decreased the most in China and the US, respectively. In 1990-2019, the asthma mortality rate was higher in China than in the US; however, the mortality gap has narrowed. Mortality increased with age in adults. The improvements in asthma death risk with period and birth cohort were more obvious in China than in the US. Smoking, high BMI, and aging are major health problems associated with asthma control. The role of occupational asthmagens in asthma mortality underscores the importance of management and prevention of occupational asthma.

Recurrence of wheeze in preschool aged children: a retrospective cohort study in primary care

Abstract Background Approximately 1 in 7 children with wheeze will be admitted to hospital for treatment, often leading to repeat visits to emergency departments and hospital admissions. The UK lags other wealthy countries in the management of preschool wheeze and has amongst the highest rates of asthma deaths in Europe. There were reports that wheeze and asthma admissions to hospitals fell during the Covid-19 pandemic lockdowns, but the changing community incidence is unknown. We aimed to report the changing incidence of recurrent wheeze across the Covid-19 pandemic. Methods Using data from the UK Clinical Practice Datalink, a nationally representative sample of the UK population, we followed a cohort of 57,603 children aged 1-5 years who consulted their general practitioner with their first wheeze attack between January 2009 and July 2020. We calculated the incidence of wheezing recurrence by calendar year. We will calculate the incidence rate ratios for recurrent wheeze by level of area-based deprivation whilst accounting for potential confounders including child age, sex, birth weight, gestation age, ethnicity, comorbidities, bronchiolitis, maternal smoking, maternal asthma, and maternal age at birth. Results The incidence of recurrent preschool wheeze remained stable across the Covid-19 pandemic (e.g., 2019: 27% vs 2020: 23%) even though total wheeze events in general practice fell from 3,135 in 2019 to 1,280 in 2020. Conclusions Around a quarter of children with wheeze have repeat visits to the GP. Our next steps are to identify preventive actions to reduce the risks of recurrent wheeze for children presenting with their first wheeze attack in primary care. Key messages • Around a quarter of children will have a repeat visit to the GP for wheeze within the first year after their initial wheeze attack. • The incidence of recurrent preschool wheeze remained stable across the Covid-19 pandemic.

Cost-effectiveness of budesonide-formoterol vs inhaled epinephrine in US adults with mild asthma

BackgroundThe management of mild asthma has lacked an over-the-counter (OTC) option aside from inhaled epinephrine, which is available in the United States. However, inhaled epinephrine use without an inhaled corticosteroid may increase the risk of asthma death. ObjectiveTo compare the cost-effectiveness of OTC as-needed budesonide-formoterol as a plausible alternative to inhaled epinephrine. MethodsWe developed a probabilistic Markov model to compare OTC as-needed budesonide-formoterol inhaler use vs inhaled epinephrine use in adults with mild asthma from a US societal perspective over a lifetime horizon, with a 3% annual discount rate (2022 US dollars). Inputs were derived from the SYmbicort Given as-needed in Mild Asthma (SYGMA) trials, published literature, and commercial costs. Outcomes were quality-adjusted life-years (QALY), costs, incremental net monetary benefit (INMB), severe asthma exacerbations, well-controlled asthma days, and asthma-related deaths. Microsimulation was used to evaluate underinsured Americans living with mild asthma (n = 5,250,000). ResultsInhaled epinephrine was dominated (with lower QALYs gains at a higher cost) by both as-needed budesonide-formoterol (INMB, $15,541 at a willingness-to-pay of $100,000 per QALY) and the no-OTC inhaler option (INMB, $1023). Adults using as-needed budesonide-formoterol had 145 more well-controlled asthma days, 2.79 fewer severe exacerbations, and an absolute risk reduction of 0.23% for asthma-related death compared with inhaled epinephrine over a patient lifetime. As-needed budesonide-formoterol remained dominant in all sensitivity and scenario analyses, with a 100% probability of being cost-effective compared with inhaled epinephrine in probabilistic sensitivity analysis. ConclusionIf made available, OTC as-needed budesonide-formoterol for treating mild asthma in underinsured adults without HCP management improves asthma outcomes, prevents fatalities, and is cost-saving.

At-home asthma mortality unchanged despite declining mortality in other settings: US death certificate data (2000-2019)

BackgroundAsthma mortality rates in the United States have declined since 1999; however, asthma mortality by place of death has not been comprehensively evaluated. ObjectiveTo evaluate temporal trends in asthma mortality rates and place of death in the United States. MethodsWe conducted a population-based analysis using data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research platform to evaluate deaths with asthma as the underlying cause (2000-2019) among US residents of all ages. Absolute numbers of asthma-related deaths were described by place of death. Counts were applied to US Census Bureau population counts to calculate mortality rates per 100,000 persons. ResultsIn the 20-year period evaluated, 67,695 asthma deaths were registered in the United States. An overall 32% decline in the asthma mortality rate was observed, from 1.43 to 0.98 per 100,000 persons from 2000 to 2019, respectively. Although asthma mortality rates declined in all medical facility locations, the at-home asthma mortality rate remained stable (0.32 and 0.34 per 100,000 persons in 2000 and 2019, respectively). Consequently, the proportion of at-home asthma deaths increased from 23% in 2000 to 2001 to 36% in 2018 to 2019. The distribution of place of death varied by age, sex, race, ethnicity, and geographic region. ConclusionDespite an overall decline in asthma mortality in the United States, at-home asthma mortality has remained unchanged. In recent years, more than one-third of asthma deaths have occurred at home. These findings warrant further study and underscore the importance of increased efforts to identify and treat uncontrolled asthma across demographic groups.

Evaluation of the efficacy of asthma information videos ('Moving On Asthma') at improving knowledge in teenage children.

Asthma is a common inflammatory condition that can be life threatening. The National Review of Asthma Deaths (2014) recommended: Parents and children…should be educated about managing asthma. The aim of this study was to assess the efficacy of an educational video on asthma at improving knowledge in adolescent children. A 3-minasthma education video was shown to young people aged 13-15 years in two contrasting schools. Knowledge of asthma was evaluated using a 6-question form completed at 3 timepoints: baseline (pre), immediately after intervention (post), and 1 week later (delayed). A total of 151 data sets from two schools were analysed. Knowledge was significantly improved immediately after watching the video for four out of six questions, indicating that the video was successful in effectively educating the children about asthma. There was no significant change to responses between immediately after watching the video and a week later, suggesting retention of the knowledge gained from viewing the intervention material. The results suggest acquisition and retention of knowledge in young people after watching a video on asthma, providing evidence to support the use of digital, video-assisted, internet-based learning tools such as the 'Moving on Asthma' website as an aid to regular clinics for young people with asthma.

Asthma in the intensive care unit: A review of patient characteristics and outcomes.

Most asthma-related deaths occur in low- and middle-income countries, and South Africa (SA) is ranked fifth in global asthma mortality. Little is known about the characteristics and outcome of asthma patients requiring intensive care unit (ICU) admission in SA. To identify and characterise patients with acute severe asthma admitted to the respiratory ICU at Groote Schuur Hospital, Cape Town, SA, in order to evaluate outcomes and identify predictors of poor outcomes in those admitted. We performed a retrospective descriptive study of patients with severe asthma admitted to the respiratory ICU at Groote Schuur Hospital between 1 January 2014 and 31 December 2019. One hundred and three patients (110 admission episodes) were identified with an acute asthma exacerbation requiring ICU admission; all were mechanically ventilated. There was a female preponderance (53.6%; n=59/110), with a median (range) age overall of 33 (13 - 84) years. Of all admissions, 40 (36.4%) were current tobacco smokers and 16 (14.5%) patients with a history of substance abuse. Two thirds (60.0%; n=66/110) of the patients were using an inhaled corticosteroid (ICS). No predictors of mortality were evident in multivariate modelling, although those who died were older, and had higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores and longer duration of admission. Only 59 of the surviving 96 individual patients (61.5%) attended a specialist pulmonology clinic after discharge. Among patients admitted to the respiratory ICU at Groote Schuur Hospital for asthma exacerbations, there was a high prevalence of smokers and poor coverage with inhaled ICSs. Although mortality was low compared with general ICU mortality, more needs to be done to prevent acute severe asthma exacerbations. What the study adds. Intensive care unit (ICU) admission represents the most severe form of exacerbation of asthma. South Africa (SA) has a very high rate of asthma deaths, and this study demonstrates that admission to an ICU with a very severe asthma exacerbation frequently results in a good outcome. However, many of the patients admitted to the ICU were not adequately treated with background asthma medications prior to their admission. Implications of the findings. Death from asthma should be avoidable, and admission to an ICU is not associated with high mortality. Patients are therefore likely to be dying at home or out of hospital. Better education and access to medication and early access to health services rather than improved in-hospital care would potentially alter SA's high asthma mortality.

Programmed Cell Death in Asthma: Apoptosis, Autophagy, Pyroptosis, Ferroptosis, and Necroptosis.

Bronchial asthma is a complex heterogeneous airway disease, which has emerged as a global health issue. A comprehensive understanding of the different molecular mechanisms of bronchial asthma may be an efficient means to improve its clinical efficacy in the future. Increasing research evidence indicates that some types of programmed cell death (PCD), including apoptosis, autophagy, pyroptosis, ferroptosis, and necroptosis, contributed to asthma pathogenesis, and may become new targets for future asthma treatment. This review briefly discusses the molecular mechanism and signaling pathway of these forms of PCD focuses on summarizing their roles in the pathogenesis and treatment strategies of asthma and offers some efficient means to improve clinical efficacy of therapeutics for asthma in the near future.

The evaluation of asthma by gender and age groups in Turkey, in 1990-2019: incidence, prevalence, mortality, and disability-adjusted life years

Aims: The aim of this study was to evaluate the incidence and prevalence of asthma, asthma-related DALYs and deaths, and risk factors for asthma by genders and age groups during the study years in Turkey. Methods: The data used in the study were obtained from the estimation data prepared by the Institute for Health Metrics and Evaluation on asthma for Turkey by the global burden of disease study covering the years 1990-2019. During the study years period, death from asthma and Disability-Adjusted Life Years (DALYs) were used as dependent variables. In addition, the effects of Occupational Asthmagens (OA), Smoking (SM), and High Body Mass Index (HBMI), which are known as risk factors for asthma-related deaths and DALYs, were investigated. Comparisons of the variables according to gender and age groups were made with the Mann-Whitney test. The relationships between the variables were examined with the Spearman rank correlation coefficient (Rho). Results: A statistically significant difference was found between the mean rank of total prevalence number, total incidence number, total number of deaths and DALYs scores by gender. Asthma-related deaths due to risk factors (OA, HBMI, SM) were found to be correlated with DALYs and the total number of asthma deaths. Total asthma deaths, and asthma-related deaths because of HBMI and DALYs because of HBMI-induced asthma in women; deaths from asthma because of OA, SM, and DALYs from asthma because of OA and SM were found to be higher in males. Conclusion: HBMI in women and SM and OA in men stand out as risk factors. Therefore, as a result of a detailed investigation of the risk factors leading to the development of asthma, policies should be developed for gender and age groups, and necessary precautions should be taken.

Health and Safety Effects of Airborne Soil Dust in the Americas and Beyond

AbstractRisks associated with dust hazards are often underappreciated, a gap between the knowledge pool and public awareness that can be costly for impacted communities. This study reviews the emission sources and chemical, physical, and biological characteristics of airborne soil particles (dust) and their effects on human and environmental health and safety in the Pan‐American region. American dust originates from both local sources (western United States, northern Mexico, Peru, Bolivia, Chile, and Argentina) and long‐range transport from Africa and Asia. Dust properties, as well as the trends and interactions with criteria air pollutants, are summarized. Human exposure to dust is associated with adverse health effects, including asthma, allergies, fungal infections, and premature death. In the Americas, a well‐documented and striking effect of soil dust is its association with Coccidioidomycosis, commonly known as Valley fever, an infection caused by inhalation of soil‐dwelling fungi unique to this region. Besides human health, dust affects environmental health through nutrients that increase phytoplankton biomass, contaminants that diminish water supply and affect food (crops/fruits/vegetables and ready‐to‐eat meat), spread crop and marine pathogens, cause Valley fever among domestic and wild animals, transport heavy metals, radionuclides and microplastics, and reduce solar and wind power generation. Dust is also a safety hazard to road transportation and aviation, in the southwestern US where blowing dust is one of the deadliest weather hazards. To mitigate the harmful effects, coordinated regional and international efforts are needed to enhance dust observations and prediction capabilities, soil conservation measures, and Valley fever and other disease surveillance.