Asthma mortality rates declining, but ‘epidemic’ looming

Joe Zein

The mortality rate from asthma decreased 42% between 1999 to 2015, but cases of asthma are increasing, with no plateau or decrease in sight, according to findings presented at CHEST 2017.

“Asthma mortality has improved in the last 2 decades, primarily in patients 65 years and older and across all races and in both men and women,” Joe Zein, MD, of the Cleveland Clinic’s Respiratory Institute, told Healio Family Medicine. “We hypothesize that these results reflect improvement in asthma care overall over the last 2 decades.”

Zein and colleagues conducted a population-based study using CDC’s Wide-Ranging Online data for Epidemiologic Research (WONDER) data. They selected all patients aged 15 and older who had died of asthma between 1999 and 2015, using a Spearman correlation test to analyze the trends.

Researchers found an overall incidence rate of 1.5 deaths per 100,000. White men had the lowest mortality (0.9 deaths per 100,000) and African American women had the highest age-adjusted asthma mortality (3.4 deaths per 100,000). There were 2.1 asthma-related deaths per 100,000 in 1999 vs. 1.2 deaths per 100,000 in 2015 (P < .001).

Zein said he was “very reassured” by data that indicate asthma mortality improved over the past 2 decades, and discussed future asthma trends.

“Physicians will soon be facing an ‘asthma epidemic’ among the elderly population due to two major factors,” he said. “First, the world is getting older — there will be more than 2 billion individuals older than 60 years by 2050. Second, asthma is, per se, more severe in this population group.”

The line between asthma and other diseases in these older patients is not always clear, Zein continued.

“The symptoms of asthma in elderly patients are frequently related to other diseases such as deconditioning and heart failure. In addition, older patients are not very active, so they do not report exercise-induced shortness of breath. Physicians should be aware of these pitfalls in diagnosing asthma in the elderly and should have a very low threshold to make such a diagnosis. They should be encouraged to ask patients about respiratory symptoms in elderly patients and then perform office spirometry for those with symptoms,” he said.

Zein agreed with previous research that showed spirometry is extremely important in diagnosing asthma, but usage is lacking.

“Spirometry is underutilized in primary care,” he said. “Often, patients with asthma or COPD get started on inhalers without spirometry. “Any physician should consider spirometry the moment they consider giving an inhaler. Primary care physicians can perform spirometry in their office using a portable spirometer, and learning how to interpret a simple spirometry to confirm or refute a diagnosis of asthma and document a patient’s response to therapy is very easy.” – by Janel Miller

References:

CDC. Spirometry. https://www.cdc.gov/niosh/topics/spirometry/refcalculator.html. Accessed Nov. 10. 2017.

Yaqoob, ZJ et al. Control ID: 2740841. Presented at: CHEST Annual Meeting. Oct. 28–Nov. 1, 2017; Toronto.

Disclosures: Zein reports no relevant financial disclosures. Healio Family Medicine was unable to determine the other authors’ relevant disclosures prior to publication.