FCAAIA Notes: It is heartening to see this report of declining asthma mortality, particularly among older Americans. There are probably numerous reasons why including better recognition and therefore more frequent diagnosis of the disease, more appropriate preventive treatment plans, and newer medications including monoclonal antibodies that decrease asthma morbidity and mortality.

Of course, asthma mortality rates had increased steadily for a couple of decades before they started to level off (and now apparently decline). Nonetheless, several thousand Americans still die every year from asthma.  Those with poorly controlled and severe asthma are at greatest risk.

Many people do not even recognize that their asthma is not well controlled, as they accommodate to lower than their personal best lung function.  Thus, we routinely request follow-up with our asthma patients and check lung function tests even if they report they are doing well. Let’s make sure you are as well as you can be.

(Source: Nov. 1, 2017 For Medscape articles: User name: FCAAIA, Password: Allergies).

Deaths attributed to asthma have been falling in the U.S., a researcher said here, with the sharpest drops coming among older Americans.

In a retrospective analysis of surveillance data from 1999 to 2015, the rate of deaths blamed on asthma fell from 2.1 to 1.2 per 100,000 people, according to Gretchen Winter, MD, of the Cleveland Clinic.

The drop was evident in all age groups, but was most dramatic among Americans 65 and older, Winter reported here at CHEST, the annual meeting of the American College of Chest Physicians.

Winter said the death rate slowed despite the increasing prevalence of the condition in the U.S., where in 2013 an estimated 23 million people were living with asthma, including 9 million children.

In that year, she said, the CDC estimated that asthma accounted for 3,630 deaths, 18 million emergency department visits, nearly 350,000 hospital admissions, and a total cost exceeding $20.7 billion.

Moreover, evidence suggests that asthma in older people is “under-perceived, under-diagnosed, and under-treated,” she said, while, compared with asthma in younger people, it is more severe, harder to treat, associated with increased use of inhaled medications, and linked to a greater risk of treatment failure.

A 2016 analysiss showed that crude asthma mortality among those 65 and older was markedly higher than it was among younger people, she noted.

“A lot of people might say, well they’re old, they have other health issues that are contributing to that,” Winter said, but the disparity remained after adjusting for age-related factors.

To examine the issue, she and colleagues turned to the CDC‘s WONDER database (for Wide-ranging Online Data for Epidemiologic Research) and, using death certificates and ICD-9 codes, found 61,815 deaths with asthma given as an underlying cause.

Combining that information with census data gave an overall rate of 1.5 deaths per 100,000 people every year, she said, falling about 50% from 1999 to 2015. The highest age-adjusted overall mortality rate was among African-American women and the lowest among white men, at 3.4 and 0.9 per 100,000 people, respectively.

When the researchers divided their sample along age lines, they found declines over time in all age groups, but the sharpest fall was among those 65 and older — from about 6.5 deaths per 100,000 in 1999 to just over 3.0 per 100,000 in 2015.

The data showed that women 65 and older had higher asthma prevalence and mortality than did men in the same age group, but in both the rate of death fell pretty much in lockstep, she said. The change was also consistent across race and ethnic groups, Winter added.

The finding is “good news,” commented Sonali Bose, MD, of Mount Sinai Hospital in New York City, who was not part of the study but who co-moderated the session at which details were presented.

Bose told MedPage Today there has been a “change of awareness … over the years” about asthma among older Americans on the part of healthcare providers, although that is probably not the whole story.

Asthma medicines have improved and so have the devices used to deliver them, she said. “Both will have an impact on asthma control and we hope on asthma deaths,” Bose said. “There are a lot of factors that go into epidemiological data like this.”

But she added that better diagnosis and increased awareness of the burden of asthma in their older patients probably means healthcare providers played their part as well.

Winter said the nature of the data prevent them from making any statements about the cause of the change, but she and colleagues hypothesize that it’s a result of better diagnosis and management.

That suggests, she concluded, that the “negative impact of aging on asthma-related death can be moderated” with emphasis on early diagnosis and attention to treatment.

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