Demographic characteristics of patients with severe life threatening asthma: comparison with asthma deaths.

Richards, Gail; Kolbe, John; Fenwick, J; Rea, Harold

doi:10.1136/thx.48.11.1105

Cited by 74 publications

(56 citation statements)

References 19 publications

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“…The mortality rate of patients admitted to the ICU (2.2%) is similar to the overall in-hospital mortality reported in other studies [15,16]. Of greater concern is the large proportion of deaths at health facilities in general hospital wards or clinics, which accounted for one third of deaths in people v55 yrs.…”

Section: Discussionsupporting

confidence: 67%

Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980–1997

et al. 2001

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Over the past two decades, changes in the health services designed to improve access to and quality of asthma care have occurred in South Africa. The aim of this study was to investigate the incidence of fatal and near-fatal asthma (NFA) from 1980–1997 in an urban part of South Africa.A retrospective analysis of fatal asthma and NFA in the Cape Town City Council area was performed. Mortality data were obtained from death notification records. Data on NFA were obtained from the records of patients admitted for asthma to intensive care units (ICUs) at major academic hospitals serving the area.There were 1,506 deaths (mean age 56 yrs) from asthma reported; 39 and 3% occurred in people under 55 and 15 yrs, respectively. Average annual asthma mortality rate (8.1±1.9 per 100,000 population) was highest amongst people of mixed race (10.1±2.0), followed by Blacks (6.8±3.1) and Whites (5.0±1.9, p<0.001). Asthma mortality declined by 0.28 deaths per 100,000 population per year; rates decreased in all ethnic groups. Most deaths (72.3%) were outside a health facility and a higher number of deaths occurred on weekends (223 deaths·day−1) than weekdays (207 deaths·day−1, p=0.014). Paediatric asthma ICU admissions declined by 1.81 children·yr−1. The annual number of adults admitted to ICU for asthma, and the proportion requiring intermittent positive pressure ventilation did not change.These results indicate that the incidence of fatal and near-fatal asthma in this area has declined over the period and this may reflect improved asthma management. However, the relatively high asthma mortality rate in people of mixed race and the predominance of deaths outside health facilities and on weekends suggest problems with access to care.

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Section: Discussionsupporting

confidence: 67%

Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980–1997

et al. 2001

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“…In a population-based study, nearly 10% of patients admitted to the ICU for asthma died during the next two years [20]. Similarly, a significant proportion (15%) of 121 patients discharged from an ICU following mechanical ventilation died from asthma within six years [21].…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective cohort study of adult health maintenance organization (HMO) members hospitalized for asthma, the impact of ICS and IBA dispensing on the risk of intensive care unit admission, a surrogate for life-threatening asthma exacerbation, was studied [20,21]. Using multivariate analysis, the potential confounding effect of asthma severity was controlled for.…”

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confidence: 99%

Beta agonists, inhaled steroids, and the risk of intensive care unit admission for asthma

et al. 2001

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Although inhaled corticosteroid (ICS) use is associated with a decreased risk of hospitalization for asthma, the impact of ICS on the risk of life-threatening asthma exacerbation is less clear. The effect of ICS and inhaled beta agonist (IBA) dispensing on the risk of intensive care unit admission for asthma, a surrogate for lifethreatening exacerbation, is evaluated.Using computerized International classification of diseases (ICD)-9 discharge diagnoses, a cohort of all 2,344 adult Northern California members of a health maintenance organization hospitalized for asthma over a 2-yr period were identified. Computerized pharmacy data was used to ascertain asthma medications dispensed during the 3-, 6-, and 12-month intervals preceding index hospitalization for asthma.During the 3-months preceding hospitalization, a minority of subjects had no IBA units dispensed (34%), with 14% receiving low level (1 unit), 20% medium level (2 -3 units), and 32% high level (¢4 units) therapy. A substantial proportion received no ICS units (55%), whereas 13% had low, 16% medium, and 15% high level therapy. In multiple logistic regression analysis, high level IBA use was associated with a greater risk of intensive care unit (ICU) admission for asthma after controlling for asthma severity. There was no relationship, however, between low or medium level IBA use and ICU admission. Conversely, medium level and high level ICS use were associated with a reduced risk of ICU admission. Analysing 6-and 12-month medication dispensing data, similar risk patterns were observed.Inhaled corticosteroid dispensing was associated with reduced risk of intensive care unit admission among adults hospitalized for asthma, whereas the opposite applied for high dose beta agonist usage. This suggests that ICS prescription to adults with moderate-to-severe asthma could reduce the risk of life-threatening exacerbation.

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“…43 Adverse psychological characteristics and social problems have been identified as the major potentially modifiable factors in preventing asthma deaths. [21][22][23]44,45 For example, in two British studies, 21,22 >70% of patients dying from asthma had significant psychological or social factors which may have contributed to their deaths. In an Australian study the figure was 86%.…”

Section: Psycho-social Factors In Asthmamentioning

confidence: 99%

A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma

Smith

Mugford

Holland

et al. 2005

Health Technol Assess

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Demographic characteristics of patients with severe life threatening asthma: comparison with asthma deaths.

Abstract: Background-Studies of mortality from

Cited by 74 publications

References 19 publications

Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980–1997

Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980–1997

Beta agonists, inhaled steroids, and the risk of intensive care unit admission for asthma

A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma

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