OBSERVATIONS ON ASTHMA MORTALITY

The rate of death from asthma in the United States has been increasing over the last decade, but such deaths still remain uncommon. Mortalit y rates differ markedly by region and ethnicity, and case-fatality rat es are highest in black men living in inner cities. In general, patien ts in greatest jeopardy are those with severe, unstable disease who ar e not being objectively monitored; however, death can occur in anyone ii the attack is intense enough. Sudden catastrophic episodes of asthm a occur but are very rare. Failure to recognize the seriousness of the terminal episode or to treat the episode appropriately remains the ch ief contributing cause of poor outcome. Little compelling evidence sho ws that adverse effects of medications play much of a role in asthma-r elated death. The disease characteristics that place patients at risk remain inadequately defined. Of those suggested, only a history of rec urrent hospitalization and the need for ventilatory assistance are spe cific enough to be helpful. These characteristics, however, are found in only 36% and 6% of cases, respectively; thus, their absence is of n o Value in assessing risk. The prognosis after a near-fatal episode of asthma is poor, and approximately 10% of patients die in the year aft er the event. Given the current state of knowledge, it is wise to view all exacerbations of asthma that last longer than a few days as poten tially fatal and to treat them accordingly. This is especially true in patients who have previously had a severe episode of asthma.