Background: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. Methods: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008–December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. Results: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. Conclusion: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.

Additional Metadata
Keywords Asthma epidemiology, Cohort studies, Mortality, Severe asthma
Persistent URL dx.doi.org/10.1016/j.rmed.2020.105919, hdl.handle.net/1765/125342
Journal Respiratory Medicine
Citation
Engelkes, M, de Ridder, M.A.J, Svensson, E. (Elisabeth), Berencsi, K, Prieto-Alhambra, D. (Daniel), Lapi, F, … Verhamme, K.M.C. (2020). Multinational cohort study of mortality in patients with asthma and severe asthma. Respiratory Medicine, 165. doi:10.1016/j.rmed.2020.105919