Increase In Asthma Mortality Research Articles

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

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

Association between ambient sulfur dioxide pollution and asthma mortality: Evidence from a nationwide analysis in China

There is a lack of research on the effects of acute exposure to ambient sulfur dioxide (SO2) on mortality caused by asthma, especially nationwide research in China. To explore the acute effect of exposure to ambient SO2 on asthma mortality using nationwide dataset in China from 2015 to 2020 and further evaluate the associations in subgroups with different geographical and demographic characteristics. We used data from China’s Disease Surveillance Points system with 29,553 asthma deaths in China during 2015–2020. The exposure variable was the daily mean concentrations of SO2 from the ChinaHighSO2 10 km × 10 km daily grid dataset. Bilinear interpolation was used to estimate each individual’s exposure to air pollutants and meteorological variables. We used a time-stratified case crossover design at the individual level to analyze the exposure response relationship between short-term exposure to SO2 and asthma mortality. Stratified analyses were carried out by sex, age group, marital status, warm season and cold season, urbanicity and region. Significant associations between short-term exposure to ambient SO2 and increased asthma mortality were found in this nationwide study. The excess risk (ER) for each 10 μg/m3 increase in SO2 concentrations at lag07 was 7.78 % (95 % CI, 4.16–11.52 %). Season appeared to significantly modify the association. The associations were stronger in cold season (ER 9.78 %, 95 % CI:5.82 −13.89 %). The association remained consistent using different lag periods, adjusting for other pollutants, and in the analysis during pre-Corona Virus Disease 2019 (COVID-19) period. Our study indicates increased risk of asthma mortality with acute exposures to SO2 in Chinese population. The current study lends support for greater awareness of the harmful effect of SO2 in China and other countries with high SO2 pollution.

Long-term association between urban air ventilation and mortality in Hong Kong

While associations between population health outcomes and some urban design characteristics, such as green space, urban heat islands (UHI), and walkability, have been well studied, no prior studies have examined the association of urban air ventilation and health outcomes. This study used data from Hong Kong, a densely populated city, to explore the association between urban air ventilation and mortality during 2008–2014. Frontal area density (FAD), was used to measure urban ventilation, with higher FAD indicating poorer ventilation, due to structures blocking wind penetration. Negative binomial regression models were constructed to regress mortality counts for each 5-year age group, gender, and small area group, on small area level variables including green space density, population density and socioeconomic indicators. An interquartile range increase in FAD was significantly associated with a 10% (95% confidence interval (CI) 2%–19%, p = 0.019) increase in all-cause mortality and a 21% (95% CI: 2%–45%, p = 0.030) increase in asthma mortality, and non-significantly associated with a 9% (95% CI: 1%–19%, p = 0.073) in cardio-respiratory mortality. Better urban ventilation can help disperse vehicle-related pollutants and allow moderation of UHIs, and for a coastal city may allow moderation of cold temperatures. Urban planning should take ventilation into account. Further studies on urban ventilation and health outcomes from different settings are needed.

Occupational exposure to soft paper dust and mortality

ObjectivesOccupational exposure to soft paper dust is associated with impaired lung function. Whether there is an increased risk for asthma or chronic obstructive pulmonary disease (COPD) is unclear.MethodsWe studied 7870...

Quarantining At Home Controls COVID-19 Exposes, May Increase Asthma Mortality

The novel coronavirus infection (COVID-19) firstly, was identified in December 2019 in Wuhan, China. The isolated virus was identified as genus β-coronavirus, placing it alongside other SARS and MERS. At the 1 May 2020, over 200 countries have confirmed cases, the number of patients infected by the virus has now surpassed 3,301,792 and with 233,729 deaths from the virus. Compared with mortality for the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), COVID-19 is being responsible for more total deaths because of the increased transmission speed. The WHO has raised global coronavirus Disease outbreak risk to "Very High", and SARS-CoV-2 infection was become a serious threat to public health. Acute respiratory distress syndrome (ARDS) is main problem is infected patients that leads to hospitalization of large number of people.

Short-Term Exposure to Ambient Air Pollution and Asthma Mortality.

Rationale: Short-term exposure to air pollution has been associated with asthma exacerbation and increased healthcare use caused by asthma, but its effect on asthma mortality remains largely unknown. Objectives: To quantitatively assess the association between short-term exposure to air pollution and asthma mortality. Methods: We investigated 4,454 individuals who lived in Hubei province, China, and died from asthma between 2013 and 2018. A case-crossover design and conditional logistic regression models were applied for data analyses. Exposures to particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5), particulate matter ≤10 μm in aerodynamic diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) were estimated by inverse distance weighted averages of all monitoring stations within 50 km from each case's home address. Measurements and Main Results: Each interquartile range (IQR) increase of PM2.5 (lag 3; IQR, 47.1 μg/m3), NO2 (lag 03; IQR, 26.3 μg/m3), and O3 (lag 3; IQR, 52.9 μg/m3) were positively associated with asthma mortality, with odds ratios of 1.07 (95% confidence interval, 1.01-1.12), 1.11 (95% confidence interval, 1.01-1.22), and 1.09 (95% confidence interval, 1.01-1.18), respectively. There was no evidence of departure from linearity for these associations. Further adjustment for other pollutants did not change the associations materially. We did not observe significant associations between PM10, SO2, and CO exposures and asthma mortality. Overall, the estimates remained consistent in various sensitivity analyses. Conclusions: Our results provide new evidence that short-term exposures to PM2.5, NO2, and O3 may increase asthma mortality risk. Further studies are needed to confirm our findings in other populations.

Inhaled steroids with and without regular salmeterol for asthma: serious adverse events.

Inhaled steroids with and without regular salmeterol for asthma: serious adverse events.

Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011

ObjectiveAsthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma. MethodsData were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed. ResultsThere were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1–3) days. Median costs were $2,950 (interquartile range, $1990–$4610). Native American race, older age (13–18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05). ConclusionsWith the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.

Fatal asthma; is it still an epidemic?

Background Asthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors.Methods A web search including key words related to fatal asthma in Italy between 2013 and 2015 has been performed. Concerning the cases that occurred in Veneto, subjects’ clinical records have been evaluated and details about concomitant weather conditions, pollutants and pollen count have been collected.Results Twenty-three cases of asthma deaths were found in Italy; 16 of them (69%) occurred in the Veneto Region. A prevalence of male and young age was observed. Most of patients were atopic, died in the night-time hours and during the weekends. The possible risk factors identified were the sensitization to alternaria, previous near fatal asthma attacks and the incorrect treatment of the disease. Weather condition did not appear to be related to the fatal exacerbations, whereas among the pollutants only ozone was detected over the accepted limits. Smoking habits, possible drug abuse and concomitant complementary therapies might be regarded as further risk factors.Discussion Although not free from potential biases, our web search and further investigations highlight an increasing asthma mortality trend, similarly to what other observatories report. The analysis of available clinical data suggests that the lack of treatment more than a severe asthma phenotype characterizes the fatal events.Conclusions Asthma mortality still represents a critical issue in the management of the disease, particularly in youngsters. Once more the inadequate treatment and the lack of adherence seem to be not only related to the uncontrolled asthma but also to asthma mortality.

International Trends in Asthma Mortality Rates in the 5- to 34-Year Age Group: A Call for Closer Surveillance

International time trends in asthma mortality have played an important sentinel role in the identification of two epidemics of asthma mortality in some countries in the 1960s and the 1970s and 1980s. Since then, little attention has been paid to the ongoing international time trends.Country-specific data on asthma mortality rates since 1960 in the 5- to 34-year-old age group were collated. To be included in the analysis, countries were required to have data available prior to 1980. A scatter plot smoothing technique was used to model the change in asthma mortality rates with time.Asthma mortality rates from 20 countries were included in the analysis. An increase in asthma mortality rates was found in the 1960s, with a mean increase of 53% from 0.55 per 100,000 in 1960 and 1961 to a peak of 0.84 in 1966 and 1967. This trend was followed by a progressive decline to a nadir of 0.45 per 100,000 in 1974 and 1975. A gradual increase was then found in asthma mortality rates to a peak of 0.62 per 100,000 in 1985 and 1986, with a mean increase of 38% during this period. Since the late 1980s, there has been a widespread and progressive reduction in mortality rates to a level of 0.23 per 100,000 in 2004 and 2005, with a mean reduction of 63% during this period.The widespread increase in asthma mortality in the 1980s and the subsequent, even greater reduction has largely gone unrecognized. We propose that awareness of such trends and their causes is important and that they are investigated contemporaneously.

Safety of long-acting β-agonists: urgent need to clear the air remains

The introduction of long-acting β-agonist (LABA) drugs in the 1990s was considered a major advance in bronchodilator therapy with evidence that their use led to improved lung function and quality of life 1, 2. There were also potential safety advantages due to the twice daily, fixed dose usage, which reduced the risk of overuse of β-agonist therapy in the situation of severe exacerbations. The subsequent introduction of the combination of LABA/inhaled corticosteroid (ICS) products had the added potential value of ensuring that the patient received concomitant ICS therapy while improving compliance with ICS therapy 3, 4. However, concerns about the possible risks associated with LABA therapy were raised soon after their introduction into clinical practice, with the evidence that regular LABA use had the potential to reduce bronchodilator sensitivity to β-agonists 5, 6 and induce tolerance to their bronchoprotective effects 7, which may not be restored by concurrent use of ICS 8. It also became apparent that patients using LABAs may be at risk of severe exacerbations if the symptom control achieved with LABA use led to a discontinuation of ICS therapy 9. There were also concerns about a potential risk of mortality from the Salmeterol Nationwide Surveillance Study 10. In this UK-based study of >25,000 subjects, there was a nonsignificant three-fold increased risk of asthma death in subjects treated with salmeterol compared with regular salbutamol; however, there was no increase in hospital admissions or life-threatening events. This led to the USA-based Salmeterol Multicenter Asthma Research Trial (SMART), a placebo-controlled study of the safety of salmeterol in adults with unstable asthma 11. The trial was stopped after an interim analysis of 26,000 subjects because it showed a statistically significant, four-fold increase in asthma mortality with salmeterol. Unfortunately, due to low …

Regular treatment with salmeterol for chronic asthma: serious adverse events

Epidemiological evidence has suggested a link between beta-agonists and increases in asthma mortality. There has been much debate about possible causal links for this association, and whether regular (daily) long-acting beta(2)-agonists are safe. The aim of this review is to assess the risk of fatal and non-fatal serious adverse events in trials that randomised patients with chronic asthma to regular salmeterol versus placebo or regular short-acting beta(2)-agonists. Trials were identified using the Cochrane Airways Group Specialised Register of trials. Web sites of clinical trial registers were checked for unpublished trial data and FDA submissions in relation to salmeterol were also checked. The date of the most recent search was October 2007. Controlled parallel design clinical trials on patients of any age and severity of asthma were included if they randomised patients to treatment with regular salmeterol and were of at least 12 weeks duration. Concomitant use of inhaled corticosteroids was allowed, as long as this was not part of the randomised treatment regimen. Two authors independently selected trials for inclusion in the review. Outcome data was extracted by one author and checked by the second author. Unpublished data on mortality and serious adverse events was sought. The review includes 26 trials comparing salmeterol to placebo and 8 trials comparing with salbutamol. These included 62,630 participants with asthma (including 2,380 children). In 6 trials (2,766 patients), no serious adverse event data could be obtained. All cause mortality was higher with regular salmeterol than placebo but the increase was not significant, Odds Ratio 1.33 [95% CI: 0.85, 2.10]. Non-fatal serious adverse events were significantly increased when regular salmeterol was compared with placebo, Odds Ratio 1.14 [95% CI: 1.01, 1.28]. One extra serious adverse event occurred over 28 weeks for every 188 people treated with regular salmeterol [95% CI: 95 to 2606]. There is insufficient evidence to assess whether the risk in children is higher or lower than in adults. No significant increase in fatal or non-fatal serious adverse events was found when regular salmeterol was compared with regular salbutamol. Individual patient data from the SNS study have been combined with the results of the SMART study; in patients who were not taking inhaled corticosteroids, compared to regular salbutamol or placebo, there was a significant increase in risk of asthma-related death with regular salmeterol, Odds Ratio 9.52 [95% CI: 1.24, 73.09]. The confidence interval for patients taking inhaled corticosteroids is too wide to rule out an increase in asthma mortality in this group. In comparison with placebo, we have found an increased risk of serious adverse events with regular salmeterol. There is also a clear increase in risk of asthma-related mortality in patients not using inhaled corticosteroids in the two large surveillance studies. Although the increase in asthma-related mortality was smaller in patients taking inhaled corticosteroids at baseline, the confidence interval is wide, so it cannot be concluded that the inhaled corticosteroids abolish the risks of regular salmeterol. The adverse effects of regular salmeterol in children remain uncertain due to the small number of children studied.

Three Generations of Ongoing Controversies Concerning the Use of Short Acting Beta-Agonist Therapy in Asthma: A Review

An increase in asthma mortality in 1960s noted by British authors stirred a debate about the use of beta-adrenergic therapy that has persisted in the medical literature. The cause appears to be isoproterenol and fenoterol overuse. A second debate evolved around the possible deleterious, pro-inflammatory effects, of the albuterol distomer. Most clinical studies showed improved bronchodilatation, but limited benefits from using levalbuterol. Recently, genotyping has uncovered a single nucleotide polymorphism at codon 16 that appears to affect the long term response to both regular and as needed use of albuterol, calling for a new genotype based therapeutic approach in asthma.

Safety of long-acting ??-agonists in asthma: a review

This review highlights a growing literature regarding the safety of long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids. Two studies have demonstrated a mortality increase with use of long-acting beta-2 agonists in asthmatic patients. They were not well controlled and thus raise the question of whether this mortality increase was the result of using long-acting beta-2 agonists as monotherapy or whether there is some rare susceptibility to an untoward effect of this class of medicine. When inhaled corticosteroids and long-acting beta-2 agonists are used in combination, prospective studies demonstrate improvement in asthma control and exacerbation rate. Two studies showed an increase in asthma mortality with long-acting beta-2 agonists, but they allowed beta-2 agonists to be used as monotherapy and did not address the safety of their appropriate use in conjunction with inhaled corticosteroids. Although the majority of asthmatic patients appear to benefit from the use of long-acting beta-2 agonists, a small subclass may be prone to deleterious effect. It is uncertained whether this is some rare susceptibility to these drugs, or, more likely, that this is the consequence of monotherapy with long-acting beta-2 agonists controlling the signs and symptoms while masking inflammation.

International trends in asthma mortality.

Throughout the 20th century many different patterns of asthma mortality have been observed. Following relatively stable asthma mortality rates during the first half of this century, there has been a gradual increase in asthma mortality in many countries over the last 50 years. Although a number of possible explanations have been proposed to explain this trend-including increases in asthma prevalence, increases in exposure to factors that trigger asthma attacks and changes in asthma management-their relative contribution in different countries is uncertain. Another pattern is that of sudden marked increases in asthma mortality occurring in at least seven countries in the 1960s and in New Zealand in the 1970s. Available evidence indicates that the cause of these 'epidemics' was the use of high dose preparations of two specific beta-agonist drugs, namely isoprenaline forte and fenoterol. The most recent trend observed in a number of western countries during the last decade has been a gradual reduction in asthma mortality; this may relate to improvements in the management of asthma.

Correlations of Asthma Mortality With Traffic-Related Factors: Use of Catalytic Converters and Radial Tires

: The objective of this study was to test the hypotheses that the post-1970 rise in asthma mortality in industrialized nations was related to introduction of catalytic converters and/or radial tires. : Annual asthma mortality data were plotted on linear coordinates for fraction of automobile fleet with converters or radial tires in Canada, Germany, Japan, and the United States. : Catalytic converter association could not account for asthma mortality that rose in Germany before general adoption of the technology there. Radial tire use was, however, linearly correlated with asthma mortality in all four countries. : Rising exposure to materials related to radial tire use may account for a substantial fraction of increased asthma mortality risk since approximately 1970.

The Need for a Meaningful and Practical Classification of Asthma Severity

Assessing asthma severity based on symptoms and convenient parameters, such as peak flow rates, is an indispensable method for the management of asthma. Several systems categorizing asthma severity have been developed in the United States of America, the United Kingdom, and Canada, and are routinely used to follow patients with asthma. In this issue of Clinical Medicine & Research, Colice1 reviews the features, strengths and weaknesses of these systems. When making comparisons, it is difficult to avoid the temptation to seek the best system, although any of the developed classification systems may be as useful as the next. When it comes to practical outcomes, if applied properly and consistently, these systems are valuable tools for the management of asthma and the well being of patients. It is better to have a familiar and tried classification system, even if imperfect, than to have none. As an ancient Greek proverb states, “any measure could be the best one.” The critical question in the development of any system to classify asthma severity is not in its applicability or easiness nor is it in the management of symptoms. It is in the optimal interpretation of the results, the ability to prognosticate, and especially the ability to assess the risk for fatal asthma; these are the major shortcomings of all current asthma classification systems. Asthma is a rare phenomenon in modern medicine; in spite of technological advances, improvement in mortality rates have not been demonstrated. Instead, asthma mortality has been steadily increasing over the past thirty years, especially in inner city, African-American, and pediatric populations.2,3 The mortality risk is not reflected in any of the current systems used for categorizing asthma severity. In fact 30% of all patients who die from asthma have been characterized as mild asthmatics just prior to their fatal exacerbation. Furthermore, bronchial biopsy and bronchoalveolar lavage studies have shown inflammatory changes in the airways of cases of mild asthma, even at times when there was no asthma exacerbation.3,4 Thus it appears that, at least as far as mortality risk and ongoing inflammation are concerned, there is nothing mild about “mild asthma”. Increasing asthma mortality, wide exposure of all asthma severity groups (including mild and moderate) to fatal outcome, and evidence of persistent inflammation during remission of asthma symptoms are the challenges for all current asthma severity classifications. Dr. Colice's review highlights the pathology of asthma as an inflammatory disease, the discrepancy between the severity of asthma symptoms and the severity of ongoing, underlying inflammation, and the need for regular clinical assessment of asthma control. Colice concludes with the need for developing and implementing an “index of airway inflammation” based on objective findings.

Beta2-agonist eutomers: a rational option for the treatment of asthma?

Beta2-adrenoceptor agonists (beta2-agonists) such as albuterol (salbutamol) and terbutaline and their long-acting analogs salmeterol and formoterol are widely used as bronchodilators in the treatment of asthma. They are chiral drugs historically marketed as racemic mixtures of an active (eutomer) and essentially inactive (distomer) stereoisomer. Despite their obvious therapeutic value and widespread use, beta2-agonists have been implicated, somewhat controversially, in causing an increase in asthma mortality and a deterioration of asthma control by a mechanism that remains elusive. Inherent toxicity of the distomers has been widely touted as an explanation and has given rise to pressure for the replacement of the racemates with pure eutomer formulations (the so-called chiral or racemic switch). This has culminated in the recent introduction into clinical practice of the single active stereoisomer of albuterol (levalbuterol) and the promise of other pure beta2-agonist eutomer formulations to follow. This article examines the evidence on which these chiral switches are based. Clinical studies designed to reveal negative effects of beta2-agonists have searched for reductions in lung function, increases in airway responsiveness to bronchoconstrictor mediators and worsening of asthma control. Crossover studies administering the pure stereoisomers and racemate of albuterol have not shown a clear superiority of the pure eutomer formulation over the racemate in terms of either bronchial hyperresponsiveness, tachyphylaxis to bronchoprotective effects or improvements in lung function. Clinical toxicity of beta2-agonist distomers on any aspect of asthmatic lung function has also not been demonstrated in the relatively short-term inhalational studies (single dose or repeated dose studies <1 week) that have been carried out. In animal studies, the administration of beta2-agonist racemates and distomers has been shown to enhance bronchial hyperresponsiveness but only in ovalbumin-sensitized animals where the relevance to humans is questionable. The pharmacokinetics and metabolism of beta(2)-agonist stereoisomers appear to be essentially similar whether administered as single stereoisomers or as racemates. Levalbuterol may be slightly more potent than an equivalent dose given as racemate, but there is some evidence that it forms a small amount of the distomer in vivo which detracts somewhat from its purported benefits over use of the racemate. Whilst there remains a clear need for studies of longer duration with sensitive clinical endpoints to evaluate the benefits of beta2-agonist eutomers and to investigate distomer toxicity, the chiral switch for beta2-agonists in general, and for albuterol in particular, does not appear to be justified on the basis of the evidence available to date.

Asthma and allergy: a worldwide problem of meanings and management?

Asthma and allergy: a worldwide problem of meanings and management?

Trends in asthma morbidity and mortality in Japan between 1984 and 1996.

To determine whether the increased prevalence of asthma in Japan has influenced its mortality. A descriptive study was conducted by the data obtained from Patient Survey and Vital Statistics of Japan between 1984 and 1996. Asthma fatalities were expressed as the number of deaths from asthma per 100,000 asthmatic patients receiving medical treatment on the day when the survey was conducted. Mortality, prevalence and asthma fatalities showed different changing patterns among several age groups. Asthma mortality for the 10-24 and 25-44 year-old groups increased during the study period, while for other age groups, it decreased. The prevalence increased for all groups classified by age and sex. Asthma fatalities peaked in 1987 among the 10-24, 25-44 and 45-64 year-old groups, and decreased for others throughout the study period. There is a possibility that an age-specific phenomenon is at work here because asthma mortality increased only in the 10-24 and 25-44 year-old groups, although the prevalence of asthma increased in all groups, whether classified by age or sex. The asthma fatality of the 10-24, 25-44 and 45-64 year-old groups peaked in 1987: it is conceivable that this was influenced by the particular drug therapy used. The increase in asthma mortality in the 10-24 and 25-44 year-olds might be influenced by the increased prevalence.