MIAMI BEACH — Preliminary data from a fatal asthma registry suggest that asthma deaths continue to fall and are more common in the elderly, Dr. Carlos Camargo Jr. said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Dr. Camargo and colleagues at Massachusetts General Hospital, Boston, developed a standard protocol for contacting next of kin that was submitted to institutional review boards in four states: Arkansas, Missouri, Ohio, and Massachusetts. So far they have identified 222 possible asthma fatalities, a much lower number than would have been predicted in the late 1990s when asthma rates were climbing, he said. Estimates vary, but 5,500 asthma deaths occurred annually in the early 1990s compared with about 4,300 today.
An analysis of the first 20 deaths in Massachusetts showed that half occurred in patients older than 80 years. In almost two-thirds of the 20 fatalities, families reported that the patient who died had a history of anxiety or depression in the previous 12 months. Most of the 20 deaths occurred in the hospital, and almost half in patients who had visited an emergency department in the previous 12 months.
“There have been some reports in recent years on how deaths are occurring more in the elderly, but I think it's getting more dramatic,” said Dr. Camargo, chair of the academy's asthma mortality committee.
The most common triggers of death were allergens or cold weather. Nearly 75% of the 20 patients who died had reported frequent night awakening due to their asthma prior to their deaths, consistent with a more persistent affliction. The study was funded by an unrestricted grant from GlaxoSmithKline.
The finding of increasing asthma deaths in the elderly has sparked efforts to create the Veterans Affairs Fatal Asthma Project, which will match cases of asthma deaths with age-matched controls living with asthma, and which aims to evaluate their health care utilization. Veterans Affairs centers in Ohio, Wisconsin, Massachusetts, and Arizona are enrolled, but Dr. Camargo urged audience members who work in the VA to contact him to broaden participation.
Efforts to create this registry have been hampered by the Health Insurance Portability and Accountability Act and different internal review board interpretations that preclude a standard approach for contacting next of kin, he said (J. Asthma 2006;43:19–23).