Asia Pac Allergy.  2013 Jul;3(3):200-203. 10.5415/apallergy.2013.3.3.200.

The global decline in asthma death rates: can we relax now?

• Rebuck AS

• KMID: 2397314
• DOI: http://doi.org/10.5415/apallergy.2013.3.3.200

Abstract

Whilst global asthma mortality seems to be decreasing, childhood asthma incidence is rising, and early warnings from Australia show an increase in asthma-related deaths in under-15s; this article considers whether we should view the future impact of asthma with trepidation. Age-adjusted mortality statistics for asthma have been reevaluated to provide an international standard. Comparisons across regions and time are complex, yet over the last two decades asthma mortality has clearly decreased, coinciding with a significant change in asthma management. The majority of remaining asthma deaths are preventable. Nonetheless, ongoing vigilance is required. Asthma remains under-diagnosed and under-treated. Childhood asthma has become more common; it is a matter of debate whether it is also more severe. Rather than being encouraged by the fall in numbers of asthma deaths, we should focus on the surging numbers of children suffering from the disease - and the worrying increase in asthma death rates in Australian children - and work to avert future issues.

Keyword

Asthma mortality; Asthma incidence; Asthma clinical trials

MeSH Terms

Asthma*
Australia
Child
Humans
Incidence
Mortality*

Reference

1. Centers for Disease Control and Prevention, National Center for Health Statistics. U.S. report of final mortality statistics, 1979-2001. Atlanta (GA): Centers for Disease Control and Prevention;2001.

2. National Institutes of Health, National Heart, Lung and Blood Institute. Morbidity & mortality: 2002 chart book on cardiovascular, lung, and blood diseases. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health;2002.

3. American Lung Association. Trends in asthma morbidity and mortality. Washington, DC: American Lung Association, Epidemiology and Statistics Unit;2004.

4. Abramson MJ, Bailey MJ, Couper FJ, Driver JS, Drummer OH, Forbes AB, McNeil JJ, Haydn Walters E. Victorian Asthma Mortality Study Group. Are asthma medications and management related to deaths from asthma? Am J Respir Crit Care Med. 2001; 163:12–18.

5. Kesten S, Rebuck AS. Asthma in New Zealand: implications for North America. J Asthma. 1991; 28:193–199.

6. Rea HH, Garrett JE, Mulder J, Chapman KR, White JG, Rebuck AS. Emergency room care of asthmatics: a comparison between Auckland and Toronto. Ann Allergy. 1991; 66:48–52.

7. Horwitz RI, Spitzer W, Buist S, Cockcroft D, Ernst P, Habbick B, Hemmelgarn B, McNutt M, Rebuck AS, Suissa S. Clinical complexity and epidemiologic uncertainty in case-control research. Fenoterol and asthma management. Chest. 1991; 100:1586–1591.

8. Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, Boivin JF, McNutt M, Buist AS, Rebuck AS. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992; 326:501–506.

9. Spitzer WO, Ernst P, Suissa S, Boivin JF, Horwitz RI, Habbick B, Cockcroft D, McNutt M, Buist AS. Fenoterol and death from asthma. Med J Aust. 1992; 157:567–568.

10. Blais L, Ernst P, Boivin JF, Suissa S. Inhaled corticosteroids and the prevention of readmission to hospital for asthma. Am J Respir Crit Care Med. 1998; 158:126–132.

11. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. United States: Global Initiative for Asthma (GINA);2012.

12. Centers for Disease Control and Prevention- (CDC). Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep. 2007; 56:1–4.

13. Ellwood P, Asher MI, Beasley R, Clayton TO, Stewart AW. ISAAC Steering Committee. The international study of asthma and allergies in childhood (ISAAC): phase three rationale and methods. Int J Tuberc Lung Dis. 2005; 9:10–16.

14. Beasley R, Ellwood P, Asher I. International patterns of the prevalence of pediatric asthma the ISAAC program. Pediatr Clin North Am. 2003; 50:539–553.

15. Strachan D, Sibbald B, Weiland S, Aït-Khaled N, Anabwani G, Anderson HR, Asher MI, Beasley R, Björkstén B, Burr M, Clayton T, Crane J, Ellwood P, Keil U, Lai C, Mallol J, Martinez F, Mitchell E, Montefort S, Pearce N, Robertson C, Shah J, Stewart A, von Mutius E, Williams H. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997; 8:161–176.

16. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet. 1998; 351:1225–1232.

17. Chapman KR, Verbeek PR, White JG, Rebuck AS. Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. N Engl J Med. 1991; 324:788–794.

18. Partridge MR. Has ISAAC told us as much as it can? Where now? Thorax. 2009; 64:462–463.

19. World Health Organization. Global alliance against chronic respiratory diseases (GARD) basket: a package of information, surveillance tools and guidelines, to be offered as a service to countries. Geneva: World Health Organization;2008.

20. Enarson DA. Fostering a spirit of critical thinking: the ISAAC story. Int J Tuberc Lung Dis. 2005; 9:1.