Question (Warning! Death mentioned in question)

Anyone know if studies have been done re asthma deaths in mild asthmatics. As to whether they were people who wheezed in an attack or people who didn't?

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thats a good question. I've not seen any or heard of any ever being carried out. My hunch based on recent events on here though would indicate that the non-wheezers would be more likely to suffer, and that's only my guess, based on the way some get treated or should that be not treated when ill, but not wheezing.

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There is an ongoing enquiry in East of England NHS region, into all asthma deaths in that region. This article from 2005 reports on its findings 2001-2003 - thepcrj.org/journ/view_arti... 1 (space added)

It notes that most deaths (81%) were in severe asthmatics and that the sudden, unexpected deaths (in the milder asthmatics, I imagine) occurred in spring/summer, suggesting an allergic cause. And worryingly, in two thirds of cases it found that medical management failed to comply with national guidelines.

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Claire, thats very good link, but some good points made about management in an the same edition tinyurl.com/yjqxa48 that would be just as well being made in the SUFA thread

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Have just taken a look at the summary shown in the link.

While the conclusions state that most patients who died had severe asthma, the figures given in the preceeding results section are that ""53% of patients had severe asthma and 21% moderately severe disease"". I suppose then that would leave 26% with milder asthma - which is much higher than I would have imagined!

The 81% figure is for associated psychosocial factors and the overall medical care of the patient was appropriate in only 33% of cases. The conclusions section also states that ""In 80% of deaths the final attack was not sudden, and may have been preventable"" - so the 20% of sudden attacks would not necessarily have be confined to milder asthmatics.

Agree with Woody-som about good points about management being appropriate in the the SUFA thread.

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Thanks Ginny - I read it in rather a rush, had remembered seeing it a couple of years back. 26% of deaths being in 'mild' asthmatics is sobering though, albeit absolute numbers are low in the overall scheme of mortality. I remember a US based physician (now retired) telling me that the expression 'mild asthma' always made him uneasy as he feared people translated it as 'no big deal' and might not take symptoms seriously. ""How mild is mild asthma?"" was a question he found difficult to answer! Most of the child deaths I have heard about in recent years occurred suddenly in children during the summer months, who were thought to be mild/moderately affected, which is why I wondered if the sudden deaths in summer were in those more mildly affected.

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if we take these figures and work along the lines that 3 people a day die with asthma, then 285 people with mild asthma do die. Not a very nice figure to comprehend, but actually 228 of those deaths are preventable (80% non sudden attacks), so this comes back to control and where does the blame for lack of control lie.

Some could say the GP/asthma nurse for not explaining things, and to a certain degree yes, but also a huge number of patients are not compliant, but why, lack of information?

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I think you are right, woody-som, about lack of information and awareness. I referred below to a long conversation I had with an American physican about asthma in 2003, and his uneasiness about the label 'mild asthma' . The phrase he used about asthma, which stuck in my mind, was that it can be 'a moving target'. Having mild symptoms at one particular point in time does not necessarily mean that this will always be the case and people need to act on signs of deteriorating control . But there can be a kind of cognitive dissonance if people (including some health care professionals) believe they are dealing with a mild condition, so in some cases ominous signs might not be taken seriously enough. The other point he made was that, in these long term diseases, people become used to their condition and their (and their doctors') expectations of symptom control can be too pessimistic; they can also not be fully aware of subtle signs of worsening control which develop over time and then are ambushed by a severe attack.

And then there is the compliance issue - in the latest issue of Asthma Magazine there is a pertinent article about a nurse who stopped her medications after a symptom free period, thinking her asthma had gone, only to end up hospitalised for three months following a severe attack; she is still suffering the consequences.

So more awareness and better information is key, I think. The challenge is to achieve a good balance between informing people properly about what this condition can mean while avoiding making them over-anxious. I think I've mentioned before that the National Asthma Council in Australia publishes asthma mortality statistics every year (a year in arrears due to time needed to collect and analyse data), with a press release analysing the different categories (age, gender etc). Perhaps something similar should be considered in the UK.

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Hi Claire,

The whole definition of severity is one that keeps getting questioned, but I've always seen basically this as the definition.

Mild-intermittent = Symptoms less than twice a week, or less than twice a month at night, with brief exacerbations and/or PEF at lest 80%

Mild-Persistent = Symptoms twice a week or more, but less than once daily, or night time at least twice a month, with many exacerbations severe enough to restrict physical activity and/or PEF at least 80%

Moderate persistent = Daily symptoms often accompanied by daily use of rescue inhaler, night time symptoms at least once a week, exacerbations twice a week or more and severe enough to restrict physical activity, PEF 60%-80%

Severe persistent = Continual daily symptoms, frequent night symptoms and exacerbations frequent enough to restrict physical activity and PEF 60% or less.

Any one of us could quite easily move from one category to another, I've done it myself, and the key is education. No one tells new asthma suffers anything. I've seen newbies on here who we have told to get medical help, and not done it, then have complications later as they don't take it seriously to start with. Perhaps the shock tactics are what's required.

The leaflets that AUK publish should be available from GP surgeries, I was lucky as I was given the AUK peakflow diary, and found out more from here, but it was left to me.

I also would like to the Australian data model copied here. until I worked out some rough figures, I never really thought about numbers, but if actual figures were available, then maybe the numbers who unfortunately don't get either the care or the medication they need to keep them alive can be significantly reduced. Cancers and heart disease get lots of publicity, but asthma is nothing, just a wheeze, it won't hurt.....Wrong and that message really doesn't get across not just to the public but also the medical profession.

The nurse in the mag was not unusual though in stopping her medication. I know people who had asthma, and haven't taken anything for years without any sign of trouble, so I don't think that is such a problem, but being aware that the symptoms can return, and knowing that and reacting to it is the message missing again.

chris

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According to asthma review yesterday, my lung function test shows as 60% yet I've absolutely no wheeze. Perhaps the 'mild' we hear about, actually refers to 'mildy inconvenient to live with' rather than 'a degree of severity'.

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for the classification you only have to have at least one of the fields to put you in that catagory, so GM, I would put you in the moderately persistent class.

the medication for that class is medium dose inhaled steroids, with possible LABA (seretide/symbicort) or low to medium dose inhaled steroids, and leukotriene modifier (singulair/accolate)