Fatal asthma; is it still an epidemic?

Area of Science:

• Pulmonary Medicine
• Epidemiology
• Environmental Health

Background:

• Global asthma mortality remains significant, with an projected increase by 2030.
• A cluster of fatal asthma events occurred in Italy's Veneto region between 2013-2015.
• This prompted an investigation into the characteristics and risk factors of these cases.

Purpose of the Study:

• To investigate the characteristics and risk factors associated with fatal asthma events in Italy.
• To analyze clinical data, environmental conditions, and potential contributing factors.

Main Methods:

• Conducted a web search for fatal asthma cases in Italy (2013-2015).
• Evaluated clinical records for Veneto cases, collecting data on weather, pollutants, and pollen.
• Analyzed patient demographics, medical history, and potential risk factors.

Main Results:

• 23 fatal asthma cases identified in Italy; 16 (69%) in the Veneto region.
• Fatalities showed a prevalence in young males, often atopic, with deaths occurring at night/weekends.
• Risk factors included Alternaria sensitization, prior near-fatal attacks, and incorrect treatment. Ozone exceeded limits; weather was not strongly linked.

Conclusions:

• Asthma mortality shows an increasing trend, despite potential biases in the data.
• Lack of adequate treatment and poor adherence, rather than severe asthma phenotype, appear to characterize fatal events.
• Inadequate treatment and non-adherence are critical factors contributing to uncontrolled asthma and mortality, especially in young individuals.