Perspective on asthma mortality--1989.

Morbidity and mortality from asthma have been increasing in the United States and other countries. Although the reason for these changes is unknown, there are a number of possibilities. Authoritative reviews of epidemics of asthma deaths in other countries have focused on patient management, particularly the failure of patients and physicians to recognize the severity of the patients' asthma. Of great concern, however, has been the possibility that increases in asthma mortality reflect changes in the way that physicians treat asthma; most notably the use of multiple drug regimens (sometimes inappropriately) and dependence on inhaled beta agonists. Since most asthmatic patients are effectively and safely managed with present therapeutic modalities, it is essential that features that distinguish the fatality-prone asthmatic be characterized as distinctly as possible. It is reasonable to conclude that such a patient may be the patient whose asthma is not well defined, sometimes in terms of the diagnosis but more often in terms of the severity of their condition. This may be associated with a failure to utilize pulmonary function tests, and result in lack of an appropriate plan of action for exacerbations of asthma through cooperative management. As a result, there may be underutilization of corticosteroids, which are necessary for the treatment of inflammation associated with chronic asthma. Misunderstanding about the need to avoid external triggers and treat internal precipitants as well as inability to recognize the potential for medication-induced adverse effects may further characterize the fatality-prone asthmatic. Further studies are needed to confirm or to refute the speculative association between current management of asthmatic patients and morbidity and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)