Introduction The National Report on Asthma Death (NRAD 2014) highlighted important shortcomings related to asthma management and an important number of patients still die from asthma. However, the mortality rate and causes of mortality in the severe asthma services has not been previously reported.
Aim To study what patients with severe asthma die from and what is their risk of mortality
Methods All patients attending our severe asthma service who had died between March 2009 and December 2014 were identified. We retrieved data from case notes, GPs, local hospitals and local database using a pre designed proforma which included cause of death, place of death, age at time of death, clinical details on asthma duration, lung function, biomarkers, medication, exacerbations including hospitalisation and co-morbidities. Causes of death was obtained from death certificates and when available coroner’s post-mortem reports.
Results Of the 520 patients attended our service between January 2009 and December 2014, there were 24 deaths (4.6% over 72 months, 0.7% annually). The mean age of death was 51 yrs (range 21–69), 17/24 (71%) were females. 50% had poorly controlled asthma with a mean predicted FEV1 of 54%. 13/24 (61%) were on a maintenance dose of oral corticosteroids (mean dose 19 mg/day). The mean inhaled corticosteroids was 1006 µg. The cause of death was not known in 6 cases, with majority of cases died from non-asthma causes (78%) with cardiovascular disease being the most common. Asthma was the cause of death in 4/18 (22%) cases. Co-morbid diseases were prevalent particularly those that form the metabolic syndrome. Non-concordance with asthma medications and smoking history (current and ex-smokers) were also common (50% and 60% respectively).
Conclusion Although death is a rare event in our severe asthma service (0.7%), patients did die prematurely (mean age 51 yrs) usually from non-asthma causes, but asthma still accounted for death in the fifth of this group. Larger multicentre study with control data will be needed to confirm these finding and look for drivers and predictors of mortality in severe asthma.