Elsevier

The Lancet

Volume 294, Issue 7615, 9 August 1969, Pages 279-285
The Lancet

ORIGINAL ARTICLES
RISE AND FALL OF ASTHMA MORTALITY IN ENGLAND AND WALES IN RELATION TO USE OF PRESSURISED AEROSOLS

https://doi.org/10.1016/S0140-6736(69)90051-8Get rights and content

Abstract

The trends in mortality attributed to asthma during the ten-year period 1959 to 1968 have been examined in relation to the trends in the use of pressurised aerosols containing sympathomimetic bronchodilators. Between 1961 and 1966, a period which corresponded to the rapid growth of sales of pressurised aerosols, the mortality increased considerably. In the most seriously affected age-group, children aged 10-14, there was a sevenfold increase in the mortality-rate, and asthma became the fourth most common cause of death in this age-group. A striking seasonal variation in the number of deaths from asthma has been demonstrated. Older people have shown an increase in mortality attributed to asthma in the summer months only, and any increase in winter mortality is likely to have been obscured by variable factors such as epidemics of respiratory infections or severe weather. In younger persons, although asthma mortality is always higher in summer, the increase has been demonstrated at all seasons. After March, 1967, there was a profound fall in the number of deaths from asthma in all age-groups and the most recent data, for the first quarter of 1969, suggests that the downward trend is continuing; there has also been a substantial reduction in the use of pressurised aerosols although this has not been of the same relative magnitude as the reduction in mortality. There is no evidence that the downward trend in mortality is related to a reduction in the use of aerosols delivering large as opposed to small doses of isoprenaline and the effects that have been observed cannot be accounted for by a change in the age-distribution of patients using pressurised aerosols. Data from the Hospital In-Patient Enquiry showed a rise in admission of patients with asthma from 1960 to 1966, and this rise has continued in 1967 without any further increase in deaths in hospital. In the absence of environmental or other factors which might have produced these changes, it is concluded that the excess deaths, which were estimated to have numbered more than 3500 in the period 1961-67, were likely to have been the result of over use of pressurised aerosols and that the subsequent decline in mortality has resulted from a greater awareness by doctors and patients of the dangers of over use. This in turn is considered to be the result of publications which have drawn attention to this hazard.

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