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Case-control study of severe life threatening asthma (SLTA) in a developing community
  1. L van der Merwe1,
  2. A de Klerk1,
  3. M Kidd2,
  4. P G Bardin1,3,
  5. E M van Schalkwyk1
  1. 1Lung Unit, Department of Internal Medicine, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
  2. 2Centre for Statistical Consultation, University of Stellenbosch, Cape Town, South Africa
  3. 3Department of Respiratory and Sleep Medicine, Monash Medical Centre and University, Melbourne, Australia
  1. Correspondence to:
    Professor P G Bardin
    Monash Medical Centre/University, 246 Clayton Road, Clayton 3168, Melbourne, Australia;p.bardin{at}


Background: Distinct risk factors for asthma death have not been identified in developing communities. This study was conducted to distinguish risk factors for severe life threatening asthma (SLTA), a proxy for asthma death, in a developing country.

Methods: A case-control study was performed at a University Hospital serving developing communities in the Western Cape Province, South Africa, over the period October 1997 to April 2000. Thirty consecutive patients with SLTA admitted to the intensive care unit (ICU) were compared with 60 chronic asthmatic patients, without a history of SLTA, who had attended the hospital outpatient respiratory clinic over the same period.

Results: The risk of SLTA in comparison with controls increased with female sex (odds ratio (OR) 3.3, 95% CI 1.2 to 9.6, p = 0.02), rural residence (OR 8.1, 95% CI 2.6 to 25.3, p = 0.0005), and absence of a formal income (OR 5.7, 95% CI 2 to 16.6, p = 0.002). Cases were more likely to have had more than one hospital admission in the previous year (OR 8, 95% CI 2.5 to 25.2, p = 0.0009) and more than one emergency room visit in the previous year (OR 4.4, 95% CI 1.19 to 16.4, p = 0.04). Patients with SLTA were less likely to use inhaled corticosteroids (OR 5.6, 95% CI 1.9 to 16.5, p = 0.003) and more likely to use inhaled fenoterol (OR 6, 95% CI 2.2 to 16.2, p = 0.0004). Patients with SLTA also had lower mean (SE) forced expiratory volume in 1 second (FEV1) measurements (66.9 (9.5)% predicted v 82.5 (4.0)% predicted; p = 0.03) and lower FEV1/FVC ratios (60.7 (4.1)% predicted v 69.6 (1.9)% predicted; p = 0.05) documented before the episode of SLTA.

Conclusions: Risk factors for SLTA that are mainly analogous to those distinguished in other environments have been identified in a geographical area characterised by a third world socioeconomic context. Rural residence and poverty may increase the risk of SLTA.

  • FEV1, forced expiratory volume in 1 second
  • FVC, forced vital capacity
  • ICU, intensive care unit
  • SLTA, severe life threatening asthma
  • asthma
  • risk factors
  • health care
  • acute attack

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  • Funding for the study was provided by The University of Stellenbosch, School of Medicine, Cape Town, RSA and Monash University, Melbourne, Australia.

  • Competing interests: none declared