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How Can Asthma Cause Death

How Asthma Can Affect Your Brain

Medical Advisory Board

Asthma is a chronic medical condition that not only impacts your respiratory system, but can also affect your neurological health.

There are three ways asthma can affect your brain:

  • When coping with stress and anxiety
  • When asthma management becomes too stressful to handle.
  • When severe asthma goes untreated-potentially causing brain damage in extreme cases.
  • Identification Of The Controls

    We selected additional patients with severe asthma to serve as controls. The controls were chosen at random from among all of the ProAR patients with severe asthma who did not evolve to death during the study period. We made the selection using a database of all existing ProAR patient charts, in the program Microsoft Excel 2010.

    Comparison Of Characteristic Features Of Patients With Asthma And Acos

    We compared the characteristic features of patients with asthma and ACOS . Patients with ACOS were significantly older , more likely to be male , had high percentages of current and past smoking histories , low FEV1/FVC % values , and low FEV1 % predicted values . The average immunoglobulin E level was higher in ACOS patients, but the difference was not statistically significant. The percentage of patients with malignant disease was significantly higher among ACOS patients ; the percentage of patients who died among all patients was higher in patients with ACOS than those with asthma .

    Selection Of Cases For The Confidential Enquiry

    MCCDs were made available to NRAD teams at the RCP and to the local NRAD team in Northern Ireland for those deaths in that country. A total of 3544 deaths had the word asthma on their MCCDs during the 12months from February 2012. Of these 1414 deaths were classified according to the WHO ICD-10 coding system with asthma or anaphylaxis as the underlying cause of death. 2644 of the cases were excluded from consideration by NRAD: these included 2130 who were not classified with asthma as the underlying cause of death and 514 deaths in people over 75years of age where asthma was entered in part II of the MCCD. The reasons for excluding the latter group of patients included the workload involved for the small NRAD team and also, based on correspondence from clinicians, the assumption that clinicians had not seriously considered asthma as the cause of death and had completed the certificates erroneously by entering asthma in part II . While some of these cases may have died from asthma, 382 had additional comorbid conditions listed in part II of the MCCD, and 401 had pneumonia entered in part Ia of the MCCD; therefore, other diseases may have been responsible for death in many of these people.

    The remit of these panels was to determine whether the people who died actually did have asthma, and if so whether their deaths were due to asthma and what recommendations could be made on the basis of the available information.

    How Is Asthma Treated

    Death, Causes of

    Asthma treatments vary between people and the Mayo Clinic advises following a treatment planned prescribed by a doctor at the first sign of an asthma attack.

    This may include puffs from an inhaler, which provided medicine that can expand airways. Some may use a nebulizer. People with regular symptoms should be on medication to make the exacerbations less severe, Mogayzel said.

    Emergency treatment can include medication that similarly expands the airways and reduces inflammation, Mayo Clinic says. In life-threatening case, a doctor may use a breathing tube, the hospital says.

    How Many People Get Sick From Asthma

    • In 2016, asthma accounted for for 9.8 million doctors office visits4
    • In 2018, asthma accounted for 178,530 discharges from hospital inpatient care and 1.6 million emergency department visits.5,6
    • Black Americans are five times more likely than white Americans to visit the emergency department due to asthma.6

    Asthma Can Also Cause Anxiety

    It’s also important to note that asthma can actually cause anxiety as well – which in turn may further exacerbate the asthma. Asthma and shortness of breath are common triggers of panic attacks, and the general dangers and stress of the asthma experience can play a very strong triggering role in the development of long term anxiety issues.

    Sticking To Your Asthma Action Plan

    Work with your doctor to develop a personalized action plan to help keep your asthma under control. Your plan will include things like how often to take your asthma medications, when to step up your treatment, when to see your doctor, and what to do if you have an asthma attack.

    Make copies of your asthma action plan for reference. You can also keep a photo of your plan on your phone. Its a good idea to share this information with family and loved ones so they know what to do if you have an attack. If youre too ill to make your own medical decisions, they should know to get you to medical help as quickly as possible.

    Do Men Or Women Have Higher Rates Of Asthma

    • Women are more likely to have asthma than men. 9.8 percent of women have asthma, compared to 6.1 percent of men.1
    • Women are more likely to die from asthma than men.7
    • Boys are more likely to have asthma than girls. 8.4 percent of boys have asthma, compared to 5.5 percent of girls.1

    References

    Centers for Disease Control and Prevention. . 2019 National Health Interview Survey data. U.S. Department of Health & Human Services. Retrieved from:

    Ferrante, G., & La Grutta, S. . The Burden of Pediatric Asthma. Frontiers in Pediatrics6.

    Zahran, H., Bailey, C., Damon, S., Garbe, P. and Breysse, P. . Vital signs: Asthma in children United States, 20012016. .

    National Center for Health Statistics. . National Ambulatory Medical Care Survey . U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from:

    Agency for Healthcare Research and Quality. . Healthcare Cost and Utilization Project . U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from:

    National Center for Health Statistics. . National Hospital Ambulatory Medical Care Survey . U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from:

    National Center for Health Statistics. National Vital Statistics System: Mortality . U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from:

    Asthma Research

    What Are The Costs Of Asthma

    • From 2008-2013, the annual economic cost of asthma was more than $81.9 billion including medical costs and loss of work and school days:8
    • $3 billion in losses due to missed work and school days 
    • $29 billion due to asthma-related mortality, and
    • $50.3 billion in medical costs
  • The annual per-person incremental medical cost of asthma was $3,266 .8
  • Among children ages 5 to 17, asthma is one of the top causes of missed school days. In 2013, it accounted for more than 13.8 million missed school days.9
  • What Action Should You Take If You Or Someone Youre With Is Having An Asthma Attack

    Most asthma patients will have an asthma action plan in place, which outlines what to do in such an event. However, if youre not familiar with their plan, or the asthma attack catches you or them off guard, there are a number of practical steps to take to help deal with the situation.

    • Phone the medical emergency number of the country youre in, or get someone else to phone for you, and ask for an ambulance
    • Remain as calm as you can, as stress can make asthma worse. Be calm and reassuring if youre with someone whos having an attack
    • Breathe slowly and deeply, or encourage the person youre with to do so
    • Sit upright in a comfortable position and loosen any tight clothing leaning forward slightly may aid breathing during an asthma attack, so try sitting the wrong way round on a chair and lean forward onto its back
    • Use your asthma reliever inhaler while you wait for help if there is a spacer to hand, use that to deliver the medication, as a spacer helps the puffs of an inhaler get into the airways more efficiently
    • Stay with the person until help arrives and keep monitoring them. If they seem drowsy or exhausted, it could mean their asthma is getting worse.

    Be aware that cold air can make asthma symptoms worse, so avoid taking someone having an asthma attack outside.

    Causes Of Death In 54 Asthma Patients Classified By Degree Of Airflow Limitation

    We analyzed the causes of death in 54 asthma patients classified by airflow limitation. In the group with mild or moderate airflow limitation , the number of patients with malignant disease was high. In the group with severe airflow limitation , the numbers of patients with malignant disease and pneumonia were equivalent .

    Causes of death in 54 asthma patients classified by degree of airflow limitation. Causes of death in 33 ACOS patients classified by degree of airflow limitation.

    Abbreviations: ACOS, asthmaCOPD overlap syndrome; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; FEV1, forced expiratory volume in one second.

    Copd In The Canadian Population

    Jerome Bettis

    CCDSS Case Definitions

    Prevalent COPD Case Definition

    The case definition of diagnosed COPD is: an individual aged 35 years and older having at least one visit to a physician with a diagnosis of COPD in the first diagnostic field, or one hospital separation with a diagnosis of COPD in any diagnostic field ever, coded by ICD-9 491-492, 496 or ICD-10-CA J41-44. This case definition for COPD was validated by Gershon and colleagues.Footnote 44

    Only the first diagnostic field was used in physician billing claims data as not all provinces and territories had more than one diagnostic field. All fields were included from the hospital separation file as this database allows for the recording of up to 25 diagnoses.

    Based on this definition, once a case is detected, it is a prevalent case for life regardless of future contact with health services. Consequently, once someone is identified as a case, they are always included in the database as a case. All jurisdictions identified cases occurring as of 1995, with the exception of Quebec which began in 1996 and Nunavut which began in 2005.

    Incident COPD Case Definition

    Incident COPD cases were identified in the year where an individual met the case definition for the first time. A run-in period of five years, where data were collected and not reported, was employed to partially account for the prevalence pool effect; i.e., to ensure that an incident case was not a pre-existing prevalent case. .

    Denominator Definition

    Prevalence

    Causes Of Death Of 33 Acos Patients Classified By Degree Of Airflow Limitation

    We next analyzed the causes of death in 33 ACOS patients classified by airflow limitation. In the group with mild or moderate airflow limitation , the number of patients with malignant disease was high. In the group with severe airflow limitation , three patients had malignant disease; the percentage of malignant disease among all causes of death was 33.3% .

    Asthma Medicines And Treatments

    What medicines do I need to take for my asthma?

    Most people with asthma are prescribed two inhalers a reliever inhaler which is usually blue. And a preventer inhaler, often brown.

    The reliever inhaler deals quickly with symptoms when they happen. You should keep your reliever inhaler handy so its always there when you need it. It can be a life-saver in an asthma attack. But it doesnt deal with the underlying inflammation.

    The preventer inhaler is the one you need to take every day, even when youre feeling well. It keeps down the inflammation in your airways.

    When your airways are inflamed youre more likely to get symptoms like coughing and wheezing when youre around your asthma triggers. So, getting into a routine with your preventer is a good idea.

    If youre still having symptoms, even though youre taking your preventer inhaler every day as prescribed, your GP might prescribe you a Leukotriene Receptor Antagonist tablet to take every day alongside your usual preventer inhaler. Or consider a different kind of inhaler called a combination inhaler.

    Do I have to take inhalers for the rest of my life?

    Asthma is a long-term condition, so you do need to carry on treating it to keep symptoms away.

    Your asthma preventer inhaler, taken every day as prescribed, stops inflammation in your airways. It works in the background to keep symptoms away. And if you go for regular asthma reviews you can make sure youre on the lowest dose possible to control your symptoms.

    How To Control Asthma When You Have Anxiety

    Asthma is still a separate condition, and as such it is treated separately. Continue to take medications as directed by your doctor, and keep your emergency inhaler on hand just in case. Although there are links between anxiety and asthma, you’ll still need to control your asthma just as you would if you didnt have anxiety.

    But you can also look for ways to manage your anxiety. If you’re able to get your anxiety under control, you should be able to weaken the likelihood of asthma flares. In other words, if youre less anxious, youll be better equipped to cope with your asthma.

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    Factors Related To Child Asthma Deaths

    The incidence of asthma among children is not evenly distributed. Studies have shown that low-income, African American children not only have a higher rate of asthma when compared with white children, they also have the highest rate of asthma-related deaths. There is a cause-and-effect explanation for this racial disparity:

    • Poor families have less access to health care, including asthma-specific care.
    • Environmental pollutants tend to be higher in lower-income communities.
    • Crowded living conditions can lead to an increased exposure to allergens and infections, resulting in greater exacerbations.

    The current statistics also show that only a third of these pediatric deaths occurred in hospital. This would suggest that families either had little or no access to inpatient or emergency care or had little idea as to identify or treat a potentially deadly exacerbation.

    Moreover, the inconsistent access to treatment only enhances the likelihood and frequency of these attacks. Its a vicious cycle that places our most vulnerable children at greatest risk.

    Surprising Factors Increase Risk In Vulnerable Children

    Daniel More, MD

    Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.

    Advances in asthma treatment and management have resulted in a significant decline in asthma-related deaths in the United States, dropping from 2.1 deaths for every 10,000 patients in 2001 to only 1.4 deaths for every 10,000 in 2009. Thats a vast improvement from the early 1990s when the asthma death rate was at its peak.

    Despite this turnaround, the rate of hospitalization of children with asthma remains far higher than adults. The same applies to the rate of emergency care, outpatient care, and the number of severe attacks. The only measure for which adults exceeded children was mortality rates, and thats a positive thing.

    In 2007, for example, despite experiencing more attacks overall , only 185 children died of asthma that year compared to 3,262 adults. The reasons for our many, including higher rates of lung disease in adults and the closer medical surveillance o children in general.

    But, at a time in history when asthma-related fatalities are almost entirely preventable, even 185 deaths are too much. And, tragically, many of these deaths were less related to the severity of an attack and more to how the attack was treated.

    Systems For Providing Care

    The NRAD panels concluded that overall care was poor in over 80% of those who died from asthma.

    In the UK, and probably in other countries, more and more patient care is being devolved into the primary care sector, without the necessary resources and training. Historically, care for asthma has moved from secondary to primary care. In addition, the UK political control of the NHS is such that systems for care change fairly frequently, without true long-term planning; and chronic care has deteriorated. In the 1990s most general practices employed trained asthma nurses to provide chronic care . However this has changed, NRAD reported that 46% of general practice nurses doing asthma reviews had no training in this field, and none as far as we were aware had any paediatric training.

    Suggested changes

    It may be necessary to revert back to a system where specialists have more involvement in the care of people with asthma, particularly after attacks. This needs to be coupled with ongoing asthma training for generalists.

    Which Racial Or Ethnic Groups Have Higher Asthma Rates

    • See AAFAs groundbreaking research report on Asthma Disparities in America.
    • Racial and ethnic differences in asthma frequency, illness and death are highly connected with poverty, city air quality, indoor allergens, not enough patient education and poor health care.
    • The rate of asthma and the prevalence of asthma episodes is highest among Black Americans.1
    • Black children are three times as likely to have asthma compared to white children.1
    • Compared to white Americans, Black Americans are five times more likely to visit the emergency department due to asthma.6
    • Black Americans are nearly three times more likely to die from asthma than white Americans7
    • When sex is factored in, Black females have the highest rate of fatality due to asthma. In 2019, Black women were three times more likely to die from asthma than white men.7

    Can Asthma Be Cured

    Can Asthma Cause Death

    There are a number of factors known to put an individual at risk for developing certain forms of asthma, and asthma caused by allergies is the most common form of the condition.

    Immunotherapy treatment is increasingly being used to reduce allergic symptoms and there is some that children who receive immunotherapy for their allergies are less likely to develop asthma.

    That being said, a systematic review published in the journal Clinical and Translational Allergy concluded that while immunotherapy treatments for allergy have the potential to achieve reductions in symptoms, there is currently no clear evidence that lung function is improved long-term.

    More research is clearly needed to shed light on the underlying causes that lead to each individual asthma diagnosis and to develop early interventions.

    Doctors and patients must work together if we are going to challenge our understanding of asthma and change the focus from long-term treatment to prevention and cure.

    But with many individuals not taking their asthma medication as advised by their doctor, what is going to empower those with asthma to take an active role in changing the status quo?

    According to Prof. Pavord, One consequence of inhalers being used so liberally is that the diagnosis of asthma has become trivialized. Better patient education is sorely needed.

    Fewer than 50 percent of children and only between 30 and 70 percent of adults stick to their asthma treatment plan, according to a 2015 systematic .

    Global Alliance Against Chronic Respiratory Diseases

    The Global Alliance against Chronic Respiratory Diseases contributes to WHOs work to prevent and control chronic respiratory diseases. GARD is a voluntary alliance of national and international organizations and agencies from many countries committed to the vision of a world where all people breathe freely.

     

    Reducing The Burden Of Asthma

    Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.

    There are two main types of inhaler:

    • bronchodilators , that open the air passages and relieve symptoms; and
    • steroids , that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.

    People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.

    It can be difficult to coordinate breathing using an inhaler especially for children and during emergency situations. Using a spacer device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end, and a hole for the inhaler in the other. A homemade spacer, made from a 500-ml plastic bottle, can be as effective as a commercially-manufactured inhaler. 

    Access to inhalers is a problem in many countries. In 2019, only half of people with asthma had access to a bronchodilator and less than one in five had access to a steroid inhaler in public primary health-care facilities in low-income countries .

    Okay But What Is An Asthma Attackand How Can Someone Die From One

    An asthma attack can occur when an individual is exposed to asthma triggers, which can vary from person to person. It can include coughing, chest tightness, wheezing, and trouble breathing, due to airways swelling and shrinking, making less air able to get in and out of your lungs.

    Death from a fatal asthma attack is due to respiratory failure, according to Geoffrey Chupp, MD, director of the Asthma and Airways Disease Program at Yale Medicine. The airways are severely constricted from spasm of the surrounding muscle and there is inflammation and mucus in the bronchial tree to the extent that the patient cant expand their lungs adequately to exchange oxygen and carbon dioxide, he explains. They lose consciousness and their heart stops beating properly from a lack of oxygenthats when cardiac arrest, or the loss of heart function, comes into play.

    There are multiple causes for these sort of attacks, says Dr. Chupp. The patient could have a sudden attack from exposure to an allergen, such as nuts, or some kind of chemical exposure, he explains. It can even be in the setting of a viral infection such as influenza or pneumonia from a bacteria. While it most commonly happens to patients with chronically severe disease, it can happen to patients with mild disease as well.

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    Asthma Deaths: ‘my Son Collapsed Like A Flick Of A Switch’

    Deaths from asthma in England and Wales are the highest they have been in more than a decade, according to analysis of official data.

    More than 1,400 adults and children died from asthma attacks in 2018 – that’s 2.5 people out of every 100,000.

    The charity Asthma UK said too many lives were being cut short by a lack of basic care, such as inhaler checks.

    GPs’ leaders said more staff in practices were needed so doctors could spend longer with asthma patients.

    But with research linking some childhood asthmas to air pollution, NHS England said it couldn’t solve the problem on its own.

    Nearly five million people in England and Wales have asthma, a condition that affects the airways.

    It can cause breathlessness, wheezing, coughing and a tight chest.

    Overall, more than 12,700 people have died from asthma in England and Wales in the past 10 years.

    Medical Certification Of Cause Of Death In The Uk

    The UK system utilises a medical certification of cause of death with two parts. Part I is for reporting disease related to the chain of events which directly leads to death . Part II should only include diseases that contributed to the death but did not directly cause it . The World Health Organization International Classification of Diseases -10 codes are then allocated, by national statistics departments, according to an algorithm, which in some cases where asthma is entered in part II of the MCCD results in asthma being classified as the underlying cause of death .

    Knowing When To Seek Urgent Care

    None of these statistics should suggest that race and poverty are the only factors that place a child at risks. Ultimately, the same risks would apply to any children whose asthma is not being controlled, whether due to inconsistent care, the underuse of rescue medications, and the failure/inability to avoid the environmental triggers.

    There is also the simple fact that some children with asthma are sicker than others. In these children, who may be all too familiar with emergency rooms and hospital visits, the specter of a severe, the even fatal attack may seem a very real possibility. But, even for those these children, fatalities are more associated more with missed symptoms and/or delayed treated than anything else.

    According to the research:

    • Between 80 percent and 85 percent of children who died from asthma had progressive symptoms anywhere from 12 hours to several weeks before their deaths.

    What this tells us is that death is less likely to come “out of the blue” but rather in a timeframe where treatment can usually be sought. This doesnt suggest that the parents were complacent; it simply punctuates the dangers that insufficient health care places on a child with severe asthma.

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