Published online: September 4, 2018
Asthma is a commonly diagnosed respiratory disease that typically can be controlled by routine preventative medication use. Unfortunately, individuals with uncontrolled asthma can die, particularly if they fail to receive or use prescribed medications. Accurate data on the clinical courses of individuals who die from uncontrolled asthma could help inform prevention strategies.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Macy and co-workers from Kaiser Permanente Southern California determined how often asthma can be confirmed as a proximal cause of death in a large, well-defined population with active health plan membership and no acute barriers to medical care. All deaths occurring in active Kaiser Permanente Southern California health plan members between 2007 and 2015 were identified, along with the causes of death reported on death certificates. The complete electronic medical records of all individuals with asthma-coded deaths were manually audited to determine if active asthma was present prior to death, if any asthma treatment was being used, and if uncontrolled asthma was a proximal cause of death.
The researchers identified 63 (26.5%) [0.20 per 100,000 patient-years] asthma-confirmed deaths. Individuals with asthma-confirmed deaths were younger, less likely to have ever smoked, and had fewer emergency visits in the 6 months prior to death compared to those with asthma excluded as a cause of death. Individuals with asthma-confirmed deaths used preventative inhalers at very low rates. The researchers unexpectedly found that inclusion in the 2016 National Committee for Quality Assurance Health Effectiveness Data and Information Set (HEDIS) for persistent asthma was associated with a higher risk of all cause early death. Individuals with asthma-confirmed deaths were also unlikely to be in the HEDIS asthma dataset in the year they died, thus not targeted for outreach.
This study found that asthma is a very rare cause of death in Kaiser Permanente Southern California health plan members, who have very low or no acute barriers to medical care. Although they identified some characteristics of the population at risk for death, they indicated that it would be a very difficult group to prospectively identify and manage effectively. They also noted that further research into the reasons for early death after HEDIS asthma dataset inclusion is warranted.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
Fatal asthma: an audit of 30 million patient-years of health plan membership from 2007 to 2015
By Eric Macy, Janis F. Yao, Wansu Chen