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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].

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".)


Asthma ranks 32nd as a cause of death worldwide, but mortality varies among and within countries [2,3]. Based on World Health Organization (WHO) data, age standardized death rates per 100,000 range from 46.56 in New Guinea, 17.16 in India, 1.65 in China, 1.62 in Russia, 0.97 in the United Kingdom, 0.88 in the United States, 0.82 in France, and 0.24 in the Netherlands [2].

In an analysis of the WHO database using a locally weighted scatter plot smoother (LOESS) curve for the 5 to 34-year age group weighted by the individual country population, asthma mortality was essentially unchanged from 2006 to 2012, after decreasing substantially from 1993 to 2006 [4]. The analysis included the 46 countries for which data were available. The decline in death rates from 1993 to 2006 is largely attributable to the widespread use of inhaled glucocorticoids for persistent asthma and avoidance of highly potent, poorly selective beta-agonists such as isoprenaline forte and fenoterol [4].

Similar to international trends, asthma mortality in the United States has declined since reaching a peak in the 1990s (figure 1) [5]. From 2001 to 2015, United States deaths due to asthma decreased from 15 deaths per million population to 10.3 deaths per million population [6,7]. Among individuals with asthma, the rate of asthma deaths decreased from 2.1 per 10,000 persons in 2001 to 1.4 per 10,000 persons in 2009 [6].

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Literature review current through: Nov 2017. | This topic last updated: Oct 06, 2017.
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