Asthma mortality in a metropolitan county hospital, a 38-year study

A 38-year (1949-1986) retrospective chart review of 535 decedent asthmatic patients was undertaken to determine trends in asthma-related deaths. Records of 187 decedents with clinical and autopsy evidence were analyzed. An overall decrease in asthma-related deaths over the four interval periods of the study was noted. Thirty-five percent of the patients died within 24 hours, and 85% died within 7 days of admission. Seventy-five percent of decedents were greater than 40 years of age. Fifty-two percent of the patients were white, 34% black, and 13% Hispanic. Mortality was higher in younger (less than 40 years) blacks and in older (greater than 40 years) whites. The number of deaths was inversely proportional to the number of patients managed in the pulmonary/ICU setting. Longer duration (greater than 10 years) of asthma was associated with a higher (60%) mortality. Mucus plugging occurred in 74% of patients. Previous hospitalization (93%), previous intubations, and inadequate assessment (peak expiratory flow rates, pulsus paradoxus) also were associated with higher mortality.