Decreases in asthma mortality in the United States.

BACKGROUND: Rates of death from asthma in the United States increased from 1978 until 1988 and have tended to stabilize since then. OBJECTIVE: To identify and evaluate recent trends in asthma mortality in the United States. METHODS: Graphing and tabulation of data from the National Center for Health Statistics identifying asthma (ICD 493) as the underlying cause of death in the 50 United States and the District of Columbia with rates of death from asthma by age, race, and sex and age-adjusted rates of death by race. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989 and 2.1 in 1994 through 1996 but decreased to 2.0 in 1997. Rates decreased for black females and males and for white females in 1997. Age-adjusted rates of death from asthma decreased in 1997 for both blacks and whites. Deaths from asthma in children less than 15 years of age decreased from 191 in 1996 to 154 in 1997, the greatest decrease in any single year since 1971. CONCLUSION: Decreases in deaths from asthma in the United States in 1997 have followed stabilization of asthma mortality rates since 1988, although changes in a single year cannot establish a trend. Improved management is the most likely explanation of reversal of previous increases in asthma mortality.

Changing prevalence of allergic rhinitis and asthma.

OBJECTIVE: This review will enable the reader to discuss prevalence, risk factors, and prognosis of allergic rhinitis and asthma. DATA SOURCES: MEDLINE (PubMed) search using the terms allergic rhinitis, asthma, prevalence, risk factors. STUDY SELECTION: Human studies published in the English language since 1978, especially studies of relatively large populations in the United States, Great Britain, Australia, and New Zealand, with cross referencing to earlier relevant studies. RESULTS: Current prevalence of allergic rhinitis at 16 years of age in cohorts of British children born in 1958 and 1970 increased from 12% in the earlier cohort to 23% and in the later cohort. Local surveys of allergic rhinitis at approximately 18 years of age in the United States in 1962 to 1965 disclosed prevalence of 15% to 28%, while the national survey of 1976 to 1980 disclosed a prevalence of 26%. Thus, it is uncertain whether prevalence of allergic rhinitis has changed in the United States based on these limited data. Data from several sources indicate worldwide increases in prevalence of asthma. Annual Health Interview surveys indicate increases in prevalence of asthma in the United States from 3.1% in 1980 to 5.4% in 1994, but prevalence among impoverished inner city children has been much higher. Combined prevalence of diagnosed and undiagnosed asthma among inner city children has been 26% and 27% at 9 to 12 years of age in Detroit and San Diego. Positive family history and allergy are important risk factors for allergic rhinitis and asthma. Prognosis is guarded; allergic rhinitis resolves in only 10% to 20% of children within 10 years, and at least 25% of young adults who have had asthma during early childhood are symptomatic as adults. CONCLUSION: Increases in prevalence remain unexplained, but avoidance of recognized allergens should reduce the prevalence of allergic rhinitis and asthma.

Stabilization of asthma mortality.

BACKGROUND: Rates of death from asthma in the United States have increased since 1978. OBJECTIVE: To identify and evaluate recent trends in asthma mortality. METHODS: Analysis of data from the National Center for Health Statistics identifying asthma (ICD 493) as the underlying cause of death in the 50 United States and the District of Columbia with rates of death from asthma by age, race, and sex and age-adjusted rates of death by race. The Bureau of the Census provided population data by age, race, and sex that permitted calculation of rates of death at 5 through 34 years of age. The Departments of Health of Australia, Canada, Great Britain, and New Zealand provided numbers of deaths from asthma and population data from which we have calculated rates of death. RESULTS: Rates of death from asthma in the United States increased from .8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989 and have been 1.9 or 2.0 since then until an increase to 2.1 in 1994. A significant difference in regression over groups indicates a difference in average rates between 1979 through 1987 compared with 1988 through 1994. Rates of death from asthma have been much higher for white females than white males with an increasing disparity. Rates of death from asthma at 5 through 34 years of age have been much greater in blacks than whites with no significant change in rates across time from 1980 through 1994. Age-adjusted rates for blacks over all ages increased from 1.5 in 1977 and 1978 to 3.5 in 1988 with rates no higher than that until an increase to 3.7 in 1994. Age-adjusted rates for whites increased from .5 in 1977 to 1.2 by 1989 with none higher than that since then through 1994. Comparison of slopes indicates a significantly greater increase for blacks than whites (F = 68.296, P < .0001). Equality of slopes tests indicate significantly greater age-adjusted rates of increase for each race separately for 1979 through 1987 compared with 1988 through 1994. CONCLUSION: Since 1988 rates of death from asthma in the United States for most ages have stabilized at rates more than 50% higher than those of 1979, but there has been only a suggestion of stabilization of rates at 5 through 34 years of age, ages at which certification of death as due to asthma is most accurate. Rates of death have been much higher for blacks than whites, and among whites rates have increased more for females than males. These differences might be due to difference in prevalence or severity of differences in accuracy of diagnosis. Improvements in management would reduce asthma mortality.

Changing asthma mortality and sales of inhaled bronchodilators and anti-asthmatic drugs.

BACKGROUND: Increasing rates of death from asthma in the United States have stabilized somewhat since 1988. Case-control studies have suggested possible adverse effects of inhaled beta-adrenergic agonists that may have contributed to mortality. OBJECTIVE: To examine possible relationships between changing asthma mortality and sales of inhaled antiasthmatic drugs. METHODS: The National Center for Health Statistics supplied numbers and rates of death from asthma (ICD 493) by year. The Bureau of the Census supplied population data. IMS America provided estimates of total hospital and drugstore sales of inhaled beta-adrenergic agonists, cromolyn sodium, and inhaled corticosteroids by year and annual sales of AeroChambers and InspirEase kits. I calculated sales of the antiasthmatic drugs as puffs per person in the general population or doses per person for cromolyn sodium, defining a dose as a 20-mg capsule or vial or 2 mg by metered dose inhaler. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989, then decreased to 1.9 in 1990 before increasing again to 2.0 in 1991. Rates of death for blacks 5 through 34 years of age increased from 0.9 in 1980 to 1.3 in 1990 and decreased to 1.2 in 1991. Estimated total hospital and drugstore sales of beta-adrenergic metered dose inhalers increased from 10.3 puffs per person in the general population in 1976 to 31.0 in 1991; those for inhaled corticosteroids, from 0.44 puffs per person in 1976 to 5.44 in 1991. Sales of cromolyn increased from 0.047 doses per person in 1978 to 0.91 in 1991. Sales of AeroChambers and InspirEase kits have also increased. CONCLUSIONS: Since 1988 there has been some moderation in increases in rates of death from asthma while progressive increases in sales of inhaled antiasthmatic drugs have continued. These data are consistent with the likelihood that previous increases in rates of death from asthma were partly due to undertreatment.

Changing asthma mortality.

BACKGROUND: Rates of death from asthma in the United States have increased progressively since 1978. OBJECTIVE: To identify recent trends in asthma mortality. METHODS: The National Center for Health Statistics supplied asthma mortality data (ICD 493), and the Bureau of the Census supplied population data that permitted calculation and graphing of mortality data by age group, race, sex, and region and calculation and tabulation of mortality rates by state. The Departments of Health and Vital Statistics of Australia, Canada, Great Britain, and New Zealand provided data that permitted calculation and graphing of rates of death from asthma (ICD 493) in those countries. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 in 1977 and 1978 to 2.0 in 1989, fell to 1.9 in 1990 and then increased again to 2.0 in 1991. Rates have been much higher for blacks than whites; age-adjusted rates for blacks increased from 1.5 in 1977 and 1978 to 3.5 in 1991; those for whites, from 0.5 in 1977 to 1.2 in 1991. Rates of death from asthma have increased with age and across time have increased in almost all age groups. The greatest proportional increase has occurred at 10 to 14 years of age with rates of 0.1 in 1979, 0.5 in 1987, and 0.4 in 1991. Rates of death at 5 through 34 years of age have increased for both blacks and whites in all regions of the country. Increases in rates of death from asthma have also occurred in other countries, but rates have been falling in New Zealand since the peak of 8.1 in 1980 and in Australia since the peak of 5.7 in 1989. CONCLUSIONS: The recent plateau in increases in rates of death from asthma in the United States may suggest effectiveness of improved management of asthma that may have followed increased awareness of the importance of optimal management.

Association of asthma mortality with medical specialist density.

In 1980, rates of death from asthma at 5 to 34 years of age varied from .105 per 100,000 in the East North Central States to .271 in the Mountain States for whites and from .637 in the South Atlantic States to 1.343 in the Middle Atlantic States for blacks. In order to investigate possible relationships between availability of physicians and care for patients with asthma, we determined regional densities of medical specialists in allergy and immunology, emergency medicine, family practice, internal medicine, and pediatrics as listed by the Directory of Medical Specialists. Multiple linear regression analyses indicated that asthma mortality was increased in areas that had more medical specialists, even after adjustment for size of the regional area. Inadequate numbers of medical specialists do not account for higher asthma mortality rates in some regions.

You Can Control Asthma: evaluation of an asthma education program for hospitalized inner-city children.

A self-management education program was designed for staff nurses to offer children while they received medical care for asthma in the hospital. The program uses videotapes, written activity books and nurse discussion with the patient. Evaluation was conducted to assess program feasibility and impact. Pre- and post-tests of 40 children age 6-12 years revealed that the children had statistically significant increases in knowledge of and expected response to early warning signs of acute asthma, and in their sense of personal control (Health Locus of Control). Parents reported an increased use of asthma self-management techniques for acute episodes of asthma. Medical record review for a 15 month pre- and post-period indicated reductions in emergency room use. Inpatient hospital based education offers a critical opportunity to introduce asthma management skills, especially to children not reached by more traditional programs.