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This study concerning asthma deaths and bronchodilator therapy covered 33 health boards in the UK (27% of population) for 4 years from 1994 to 1998. Patients had asthma as the principal cause of death (at certification), were under the age of 65, with no other underlying non-respiratory cause. Data were gathered for the 5 year period before death using hospital and primary care sources. This group was then matched with controls from the local hospital discharged with a diagnosis of asthma within the same time period and of the same age. When matching for severity, the age of onset of asthma, presence of chronic obstructive disease, previous hospital admissions for asthma, and the number of medications prescribed were used. The total number of deaths included was 532 (22% were excluded), of which 44% occurred in hospital. It was noted that those who died had an earlier age of onset of asthma, mention of obesity, and evidence of associated chronic obstructive pulmonary disease.
Short acting β2 agonist treatment prescribed 1–5 years before death was associated with an increased risk of mortality (odds ratio 2.05, 95% CI 1.26 to 3.33, p<0.01). No such association was noted during the year preceding death. Inhaled corticosteroids showed no evidence of an altered risk of mortality, but there was a suggestion that long acting β2 drugs may be associated with a decrease in mortality risk. A number of possible explanations may underlie the observed association between short acting β2 agonist therapy and mortality, only one of which is a direct toxic effect of the drugs themselves.
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