Death in Asthma, COPD and Non-Pulmonary Hospitalized Patients
After the epidemics of asthma deaths during the 1990s, numerous International and national recent studies have confirmed a consistent decrease in mortality. Among the causes of this decline, the correct implementation of clinical practice guidelines has been postulated, and particularly, the increasingly universal use of inhaled corticosteroids as maintenance asthma treatment.
Unlike COPD, for which mortality has risen during the same period, the reduced mortality from asthma has perhaps contributed to a reduced knowledge on the clinical characteristics and circumstances of death in asthmatics. Thus, contrary to COPD patients, in whom numerous recent studies have characterized their causes of death, in asthma patients there has been considerably less research. It is well established that in COPD, serious exacerbations, respiratory failure, cardiovascular diseases, and bronchopulmonary malignancies constitute the principal causes of death. Variation in the relative importance of these causes according to the severity of COPD has also been described as lung cancer is the principal cause of death in mild COPD, while respiratory failure is in very severe COPD.
In asthma, the possible causes of death are still not well understood, except for the recognized reduced contribution of severe asthma exacerbations. The few studies available are limited to those designed with other epidemiological objectives; others have been conducted in specific population groups (women, children), or are based on series of deaths too small to draw strong conclusions.
Furthermore, the bronchial and systemic inflammation and the clinical impact of the associated comorbidities in asthma have provided evidence for suspecting that, as in COPD, asthma patients might be at a greater risk of suffering cardiovascular and cerebrovascular diseases and, therefore at risk of death due to vascular events. However, previous studies exploring this association have reported conflicting results, and few of these have managed to determine a causal relationship between asthma and cardiovascular disease. Also, the method used in some of these studies could be questioned. For example, the diagnosis of asthma was assumed from simple self-reporting by patients; and, in others, by their responses collected in a telephonic survey addressed to recognize asthma symptoms.
Our study was designed with two objectives: to determine the causes of death of patients with asthma compared with those of patients with COPD; and to establish a possible relationship between deaths from asthma and cardiovascular diseases. In Spain about 68% of deaths occur in hospitals with certain regional geographic variation. We believe that the information collected is representative because most of the Spanish population deaths occur in hospitals.
Background
After the epidemics of asthma deaths during the 1990s, numerous International and national recent studies have confirmed a consistent decrease in mortality. Among the causes of this decline, the correct implementation of clinical practice guidelines has been postulated, and particularly, the increasingly universal use of inhaled corticosteroids as maintenance asthma treatment.
Unlike COPD, for which mortality has risen during the same period, the reduced mortality from asthma has perhaps contributed to a reduced knowledge on the clinical characteristics and circumstances of death in asthmatics. Thus, contrary to COPD patients, in whom numerous recent studies have characterized their causes of death, in asthma patients there has been considerably less research. It is well established that in COPD, serious exacerbations, respiratory failure, cardiovascular diseases, and bronchopulmonary malignancies constitute the principal causes of death. Variation in the relative importance of these causes according to the severity of COPD has also been described as lung cancer is the principal cause of death in mild COPD, while respiratory failure is in very severe COPD.
In asthma, the possible causes of death are still not well understood, except for the recognized reduced contribution of severe asthma exacerbations. The few studies available are limited to those designed with other epidemiological objectives; others have been conducted in specific population groups (women, children), or are based on series of deaths too small to draw strong conclusions.
Furthermore, the bronchial and systemic inflammation and the clinical impact of the associated comorbidities in asthma have provided evidence for suspecting that, as in COPD, asthma patients might be at a greater risk of suffering cardiovascular and cerebrovascular diseases and, therefore at risk of death due to vascular events. However, previous studies exploring this association have reported conflicting results, and few of these have managed to determine a causal relationship between asthma and cardiovascular disease. Also, the method used in some of these studies could be questioned. For example, the diagnosis of asthma was assumed from simple self-reporting by patients; and, in others, by their responses collected in a telephonic survey addressed to recognize asthma symptoms.
Our study was designed with two objectives: to determine the causes of death of patients with asthma compared with those of patients with COPD; and to establish a possible relationship between deaths from asthma and cardiovascular diseases. In Spain about 68% of deaths occur in hospitals with certain regional geographic variation. We believe that the information collected is representative because most of the Spanish population deaths occur in hospitals.
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