Asthma mortality

Smith K, Pearce N, Crane J, Brngess C, Culling C. Trends in asthma mortality in New Zealand, 1908-1986. Med JAust 1990 152 572-3. 

A few epidemiological studies suggest that the overuse of p-adrenoceptor agonists is associated with an overall deterioration in disease control and a slight increase in asthma mortality. This apparent trend may be caused by several factors, the most likely of which is that patients rely too heavily on bronchodilator therapy to control acute symptoms at the expense of antiinflammatory therapy to control the underlying disease process. 

Isoproterenol is a potent bronchodilator when inhaled as a microaerosol from a pressurized canister, 80-120 meg isoproterenol causes maximal bronchodilation within 5 minutes. Isoproterenol has a 60- to 90-minute duration of action. An increase in the asthma mortality rate that occurred in the United Kingdom in the mid-1960s was attributed to cardiac arrhythmias resulting from the use of high doses of inhaled isoproterenol. It is now rarely used for asthma. 

Joseph KS. Asthma mortality and antipsychotic or sedative use. What is the link Drug Saf 1997 16(6) 351-4. 

In a report the manufacturers have discussed the epidemiological data linking the use of fenoterol to asthma mortahty in New Zealand. They pointed out that asthma mortahty started to fall in 1979 while fenoterol sales were stiU increasing. Sales of fenoterol in Austria, Belgium, and Germany were similar to those in New Zealand at the peak of the New Zealand asthma death epidemic, but asthma mortality in the other countries did not rise. The confounding problem that fenoterol was preferentially prescribed for the more severe cases of asthma was... 

Morley J. Beta agonists and asthma mortality deja vu. Clin Exp Allergy 1992 22(7) 724-5. 

Chang CC, Phinney SD, Halpern GM, Gershwin ME Asthma mortality Another opinion - Is it a matter of life and., bread J Asthma 1993 30 93-103. 

Johnson CA, Mannino DM, Ashizawa A Trends in asthma mortality. Asthma mortality in United States has risen but is similar to that in England and Wales. BMJ 1997 315 1012-1013. 

Matsuse H, Shimoda T, Matsua N, et al. Aspirin-induced asthma as a risk factor for asthma mortality. J Asthma 1997 34 314-317. 

CDC. (1996) Asthma mortality and hospitalization among children and young adults-United States, 1980-1993. MMWR, 45, 350-353. 

Inman WHW, Adelstein AM. Rise and fall of asthma mortality in England and Wales in relation to the use of pressurised aerosols. Lancet 1969 2 279-285. 

Physicians often overlook pharmacodynamic and pharmacokinetic properties of aerosolized drugs. Differences in Pj-selectivity and the presence of a partial antagonistic activity make that salbutamol and terbutaline, are thought to be less associated with disturbing side effects and asthma mortality than fenoterol (54). 

In summary, salmeterol monotherapy in asthma increases the risk of asthma mortality, and this risk is reduced by concomitant use of an inhaled glucocorticoid. There is no evidence that combination salmeterol -b fluticasone in adults is associated with increased risks of serious adverse events or asthma mortality, although the latter conclusion is limited by low statistical power in the available studies. There may be an increased risk of non-fatal serious adverse events in children using salmeterol. 

There have been no large-scale epidemiological studies, but a positive relationship between asthma mortality and regional purchases of table salt per person has been shown. In a randomized doubleblind crossover trial in subjects with moderately severe asthma, the airway response to histamine was related to urinary excretion of sodium in a dose-response way, but only in men. A low-salt diet is regarded as having a potentially positive effect in patients with asthma and may help to reduce the need for anti-asthma drugs. 

Mackay TW, Wather CG, Sudlow MF, Elton RA, Caulton E. Factors affecting asthma mortality in Scotland. Scott Med 1992 37 5-7. 

The prevalenee of asthma has increased dramatically in developed countries over the past 20 years, and air pollution has been proposed as a contributing factor. However, ambient pollutant concentrations have been decreasing during the period in which asthma mortality has been increasing, suggesting other causes may be more important. A recent study comparing the incidence of asthma in eastern versus western Europe found a higher incidence of asthma in western Europe, where pollution levels were lower (29). Mortality caused by asthma is... 

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