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. 2020 Apr-May:165:105919.
doi: 10.1016/j.rmed.2020.105919. Epub 2020 Mar 2.

Multinational cohort study of mortality in patients with asthma and severe asthma

Marjolein Engelkes  1 , Maria Aj de Ridder  1 , Elisabeth Svensson  2 , Klara Berencsi  2 , Daniel Prieto-Alhambra  3 , Francesco Lapi  4 , Carlo Giaquinto  5 , Gino Picelli  5 , Nada Boudiaf  6 , Frank C Albers  7 , Sarah M Cockle  8 , Eric S Bradford  9 , Robert Y Suruki  10 , Guy Go Brusselle  11 , Peter R Rijnbeek  1 , Miriam Cjm Sturkenboom  12 , Katia Mc Verhamme  13
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Free article

Multinational cohort study of mortality in patients with asthma and severe asthma

Marjolein Engelkes et al. Respir Med. 2020 Apr-May.
Free article

Abstract

Background: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma.

Methods: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma.

Results: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality.

Conclusion: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.

Keywords: Asthma epidemiology; Cohort studies; Mortality; Severe asthma.

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Conflict of interest statement

Declaration of competing interest FA, SC, and EB are GSK employees and own stocks/shares in GSK. NB and RS were employees of GSK at the time this research was conducted and own stocks/shares in GSK. GP, CG, KB have no conflicts to declare. FL has received grants from Chiesi, GSK and Novartis. DPA has received research grants from Amgen, Bioiberica and GSK and speaker/advisory fees from Amgen and Bioiberica, paid to his department. KV has received grants from GSK and ZonMw. MR, PR, MS and KV's institution has received unconditional research grants from Boehringer-Ingelheim, Novartis, Pfizer, Yamanouchi, Servier, and Johnson & Johnson, unrelated to the current manuscript; MR, PR, MS and KV's received an unconditional grant from GSK to conduct research on incidence and risk factors of asthma exacerbations as part of the GSK/EU-ADR alliance. ES's institution (Aarhus University) has received a grant from the GSK/EU-ADR alliance related to this study. GB has received fees for lectures and/or advisory boards of AstraZeneca, Boehringer-Ingelheim, Chiesi, GSK, Novartis, Sanofi and Teva.

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