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Identifying patients at risk for fatal asthma

J Mark Madison, MD
Richard S Irwin, MD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD


Assessing patient risk for a future fatal asthma exacerbation is important because many, if not most, asthma-related deaths are preventable if risk factors are recognized and addressed early [1].

Asthma is a prevalent disease and ranks 35th as a cause of death worldwide [2]. Based on World Health Organization (WHO) data, age standardized death rates per 100,000 range from 33.9 in Zambia, 7.5 in India, 6.2 in Russia, 5 in South Korea, 1.3 in China, 1.1 in the United Kingdom, 1 in Germany, 0.9 in the United States, and 0.8 in France [2]. After reaching a peak in the 1990s, asthma mortality in the United States, and many other countries, declined (figure 1), for reasons that are not clearly established [3]. From 2001 to 2009, United States deaths due to asthma decreased from 15 deaths per million population to 10.5 deaths per million population [4]. Among subjects with asthma, the rate of asthma deaths per 10,000 persons decreased from 2.1 per 10,000 persons in 2001 to 1.4 per 10,000 persons in 2009 [4]. In 2013, there were 3630 deaths due to asthma in the United States for a rate of 1.1 per 100,000 population [5].

The epidemiology and risk factors for fatal asthma are reviewed here. The evaluation and management of severe asthma are discussed separately. (See "Evaluation of severe asthma in adolescents and adults" and "Treatment of severe asthma in adolescents and adults".)


Patients who have frequent and severe asthma symptoms and evidence of airflow limitation are at greatest risk; however, fatal and near-fatal asthma exacerbations can occur sporadically and inexplicably in a minority of asthmatics whether the baseline level of disease activity is mild, moderate, or severe [6,7]. Therefore, any acute exacerbation of asthma may be a potentially fatal attack. (See "Treatment of acute exacerbations of asthma in adults".)

In the United States, fatalities from asthma most commonly occur in lower income, non-white, urban populations [4,5,8]. In 2013, the reported death rates from asthma per million population in the United States were 24 for non-Hispanic blacks, 10 for non-Hispanic whites, and 6 for persons of Hispanic origin, although data identifying Hispanic origin may not be strictly comparable [5]. Disparities in income, education, and access to health care are widely recognized as important contributors to differences in mortality rates among different sociodemographic groups. In this regard, an analysis showed that the higher risk of death in African-American patients compared to white patients is not explained by race differences in deaths occurring in hospital and are therefore likely due to differences that precede hospitalization, such as differences in management at home or during transportation to the emergency department [9].


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Literature review current through: Sep 2016. | This topic last updated: Jun 22, 2015.
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