A CLINICAL-STUDY OF MORTALITY DUE TO ASTHMA

Background: Despite identification of the pathophysiologic mechanisms of asthma and improvement in therapy, asthma mortality has not decreas ed in recent years. Objective: The pathophysiology and asthma-related death preventive measures were investigated with a physician-based que stionnaire survey. Methods: Questionnaires were sent to physicians pri marily involved in treating asthma in Nagasaki Prefecture, Japan. The clinical characteristics of 32 patients who died of asthma (fatal case s) from 1984 to 1992 were compared with those of 17 patients with seve re asthma who survived as a result of treatment by mechanical ventilat ion (nearly fatal cases). Results: The number of deaths due to asthma increased in the last 2 years. Fatal cases and nearly fatal cases incl uded patients with severe asthma as well as patients with mild asthma. Analysis of the clinical histories of patients judged to have died su ddenly revealed the presence of persistent wheezing in these patients for a few days prior to the fatal episode. Airway obstruction was more marked and bronchial hyperresponsiveness was greater in fatal cases c ompared with those of a group of 70 patients without a history of near ly fatal acute asthma. Conclusions: The following measures may help pr event asthma deaths. Both patients and physicians should realize that even mild episodes can lead to severe, even fatal acute asthma. The se verity of asthma should be evaluated not only by symptoms and peak exp iratory flow rates but also bronchial hyperresponsiveness. Treatment s hould include reduction of bronchial hyperresponsiveness using oral or inhaled corticosteroids.