Asthma Mortality

Andrew:: We read in the paper about asthma getting out of hand sometimes and about people dying, and I know the mortality rate from asthma has increased. Is that because of a blasé attitude or because of undiagnosed asthma?
Dr. Nathan:: The death rate is around 5,000 per year, and the number one reason patients die from asthma is lack of compliance in using their medications. That is partly because they don’t have access to it, and partly because they just stop using it because they feel good. A study out of Australia has shown that even patients with mild asthma had a 30- or 33-percent incidence of death, and this number compared very closely to patients with more moderate and more severe asthma. So the patients with mild, persistent asthma were just as likely to die from asthma as were patients with more moderate and severe disease.
Andrew:: Parents will be listening to this and they may be thinking, “What can I do?” Do you just ask your kids or teenagers if they took their medication like you would ask them if they brushed their teeth? Does that sort of reminder become part of the family activity support of the child in managing and controlling asthma?

“We have to drill into patients and other family members what control is. To me, control means normal life.”
Dr. Nathan:: It gets back to the issue that you have to spend a great deal of time trying to educate the patients or family members about the disease, about the management approach, about the benefits and side effects of the medication, and also about what the expectations of the therapy should be. My expectations are total control. Patients’ expectations are the same thing: total control. I can’t tell you how many times patients come in here and say, “I wake up at night with trouble breathing, and I just expect that. That’s what you’re supposed to do if you have asthma.” We need to re-educate those patients and say, “No, that’s not what you’re supposed to have. You’re supposed to be able to sleep through the night uninterrupted, without any breathing problems.”
We have to drill into patients and other family members what control is. To me, control means normal life.

Andrew:: You have people who are middle aged or older who’ve had asthma for many years, and the medications have made tremendous progress. They’re used to settling for less, if you will.
Dr. Nathan:: Absolutely.
Andrew:: But does that have to continue? They may say, “It’s always been this way. I’m kind of in a routine. I’ll use this medication, sometimes that. I use it kind of infrequently and I get by.” And, “No, I don’t do those activities, because I’ve never been able to do them.” Can they change, even at a late time in their life?
Dr. Nathan:: Yes. As long as patients understand the disease, they can change. Sometimes it just takes going to the right physician to explain what the disease is, what the medications are, and what the realistic expectations are for control. Unfortunately, some asthmatics who have had the disease for a long period of time no longer have complete reversibility. We think of asthma as a reversible disease, but unfortunately, somewhere between 15 and 20 percent of asthmatics get what’s called “airway remodeling”, or structural changes in the airway. These patients won’t completely reverse when they use medication, but they’ll probably be reasonably controlled if they use the proper controller medications on an ongoing basis.

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