Asthma Deaths in a Large Provincial Health System. A 10-Year Population-Based Study

To, Teresa; Simatovic, Jacqueline; Zhu, Jingqin; Feldman, Laura; Dell, Sharon D.; Lougheed, M. Diane; Licskai, Christopher; Gershon, Andrea S.

doi:10.1513/annalsats.201404-138oc

Cited by 50 publications

(39 citation statements)

References 21 publications

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“…Lung function results have been quite variable with at most small improvements in peak expiratory flow (PEF) and FEV 1 . 82 In severe asthma, several studies showed no significant improvement in FEV 1 (2), whereas others showed small but significant improvements in lung function. 56,86 In the moderate to severe asthma group, several studies showed an improvement in FEV 1 or PEF compared to either baseline or placebo in favor of omalizumab 90,94 whereas others did not.…”

Section: Efficacy In Adultsmentioning

confidence: 99%

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: While severe asthma affects approximately 5% of all individuals with asthma, this small minority of individuals accounts for a large proportion of the asthma-related costs. Greater understanding of the pathophysiology of asthma combined with the emergence of novel biologic therapies for severe asthma supported the need for a thorough review of the diagnosis, investigation, phenotyping, and management of severe asthma. OBJECTIVES: We aimed to propose a practical approach to distinguish uncontrolled asthma due to inadequate asthma management from severe asthma despite optimal asthma management. Moreover, based on emerging scientific evidence, we sought to provide guidance for characterizing individuals with severe asthma and considering a phenotype-specific management. We also aimed to review other novel new potential therapeutic approaches. METHODS: We systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert opinion, were agreed upon by unanimous consensus. MAIN RESULTS: We defined severe asthma and outlined its significant impact from the societal and patient perspectives. We outlined a practical approach to distinguish severe from uncontrolled but not severe asthma, based on stepwise investigation and management of potential reasons for uncontrolled asthma. After reviewing the current evidence we concluded that: 1) Several biomarkers (e.g. sputum or blood eosinophil count, total IgE, or FeNO) can help identify potential responders to new therapeutic options; 2) Tiotropium may be considered as an add-on therapy for individuals 12 years of age and over with severe asthma uncontrolled despite combination ICS/LABA therapy; 3) The chronic use of macrolides may decrease asthma exacerbations in individuals 18 years of age and over with severe asthma independent of their inflammatory profile; 4) Children aged 6 years and older and adults who are sensitized to at least one relevant perennial allergen and who remain poorly controlled asthmatics despite high dose ICS and a second controller can benefit from the addition of anti-IgE therapy to reduce asthma exacerbations; due to the known risk of side effects associated with high-dose ICS in children, omalizumab should also be considered in children and adolescents who repeatedly exacerbate or have poor control when therapy is stepped down from high-dose to moderate-dose ICS and at least one other controller; 5) Anti-IL5 therapies may be considered for adults 18 years of age and over with severe eosinophilic asthma who experience recurrent asthma exacerbations in spite of high doses of ICS in addition to at least one other controller; and 6) Although bronchial thermoplasty has shown a decrease in asthma exacerbations in one study, its role in the treatment of severe asthma remains uncertain. CONCLUSIONS: After reviewing existing and emerging therapies for severe asthma, we developed ke...

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Section: Efficacy In Adultsmentioning

confidence: 99%

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…These studies indicate that subjects with asthma have an increased risk of all-cause mortality which is related to the baseline FEV 1 level [12,36,38,39], although the increased risk seems to be on the decrease [14,15,17]. However, independent risk factors for mortality among subjects with asthma are seldom presented in population-based studies or for well-characterized population-based asthma cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Subjects with asthma have long been reported to have excess all-cause mortality compared to subjects without asthma [11–13], although the excess mortality among subjects with asthma seems to be declining, according to recent studies [14–17]. This excess mortality risk is related to lower pre-bronchodilator forced expiratory volume in 1 sec (FEV 1 ) [12,18–21] and large FEV 1 bronchodilation response [22], but studies presenting factors associated with mortality among subjects with asthma are scarce.…”

Section: Introductionmentioning

confidence: 99%

A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up

Bäckman

Hedman

Stridsman

et al. 2017

European Clinical Respiratory Journal

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Background and objective: Asthma is a major public health concern. The aim of this study was to characterize a large population-based cohort of adults with asthma, and to study factors associated with all-cause mortality and non-participation in a long-term follow-up. Design: Random and stratified samples from five population-based cohorts were clinically examined during 1986–2001, and all subjects with asthma were included in the study (n = 2055, age 19–72 years, 55% women). Independent associations between different risk factors and (i) mortality and (ii) non-participation in a clinical follow-up in 2012–2014 were estimated. Results: In 1986–2001, 95% reported any wheeze and/or attacks of shortness of breath in the past 12 months, and/or asthma medication use. Over the up to 28 years of follow-up time, the cumulative mortality was 22.7%. Male gender, current smoking, and lower forced expiratory volume in 1 sec of predicted (FEV1% of predicted) were independent risk factors for mortality, while obesity was associated with non-participation in the follow-up. Older ages, ischemic heart disease, and low socioeconomic status were associated with both mortality and non-participation. Conclusions: The risk factors associated with mortality in this adult population-based asthma cohort were similar to those commonly identified in general population samples, i.e. male gender, current smoking, and lower FEV1% of predicted, while obesity was associated with non-participation in a long-term follow-up. Ischemic heart disease, low socioeconomic status, and older ages were associated with both mortality and non-participation.

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“…29,30 The physician that requested hospital admission or fulfilled death certificate made the diagnosis of asthma. This is important because patients with asthma have high all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

“…This is important because patients with asthma have high all-cause mortality. 29,30 The physician that requested hospital admission or fulfilled death certificate made the diagnosis of asthma. It was notified using ICD 10 codes.…”

Section: Discussionmentioning

confidence: 99%

Urbanization is associated with increased asthma morbidity and mortality in Brazil

Ponte

Cruz

Athanazio

et al. 2016

Clinical Respiratory J

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Asthma Deaths in a Large Provincial Health System. A 10-Year Population-Based Study

Cited by 50 publications

References 21 publications

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up

Urbanization is associated with increased asthma morbidity and mortality in Brazil

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