This small retrospective review of medical records included 22 patients who died outside the hospital of asthma during a 4-year period (2004 to 2008). The study was based in Milwaukee, Wisconsin, USA.
The mean age of the patients was 32 years and 64% were African American. 77% died during the night or shortly on awakening. 55% died during the summer, in June, July, or August. A history of illicit drug, alcohol, or tobacco use was discovered in 59%. Toxicologic test results for drugs of abuse were positive in 18%.
20 out of 22 patients were using or overusing a short-acting β-agonist. None were taking long-acting β-agonists alone. Two patients were taking no medications. Lung pathologic testing revealed eosinophils in 18 (out of 22) patient. There was no neutrophil infiltration.
The risk characteristics for asthma deaths in this small study included:
- being African Americans
- symptoms at night and during the summer months
- substance abuse
- not taking anti-inflammatory asthma medications
A previous study showed that risk factors for death in asthma included lower perceived asthma control scores. The highest risk patients seem to have severe asthma but they "do not feel it" until it is too late.
Severe asthma - differential diagnosis and management (click to enlarge the image).
Asthma deaths outside the hospital in an urban community from 2004 to 2008. Mohiuddin M, Zacharisen MC, Poulos C, Levy MB. Ann Allergy Asthma Immunol. 2012 Jun;108(6):412-7.
Image source: Wikipedia, public domain.