Risk for Asthma-Related Death Linked to Insufficient Access to Therapy, Specialists

Half of asthma-related deaths analyzed in a French population study were associated with insufficient access to biologic therapy and inadequate inhaled corticosteroid (ICS) doses, and referral to specialists occurred in less than 15% of these patients. These are among study findings published in Therapeutic Advances in Respiratory Disease.

Investigators sought to characterize health care resource consumption among patients in France with asthma-related death. A prospective observational study to was initiated to review and analyze asthma-related deaths in the French National Health Insurance database from January 2013 through December 2017. Deaths related to asthma were identified using ICD-10 codes.

The analysis included 3829 patients who were stratified by age as follows: 0 to 12 years old (n=37; 35.1% female); 12 to 18 years old (n=27; 44.4% female); 18 to 75 years old (n=1194; 53% female); and 75 years of age and older (n=2571; 74.9% female). The Global Initiative for Asthma guidelines were used to define ICS daily doses.

Among patients with asthma-related death, the administration of inadequate ICS doses or no ICS in the 12 months prior to death was found in 54% of patients 0 to 12 years old; 48.1% of those 12 to 18 years old; 50.6% of those 18 to 75 years old; and 43.8% of those 75 years of age or older. Notably, some patients with asthma-related death received a high daily dose of ICS; this occurred in 14.8%  of those aged 12 to 18 and 32.8% of those 75 years of age or older.   

Dispensation rates of different therapies were also assessed. The omalizumab dispensation rate was 2.8% for 18 to 75 year olds and 1.1% for those 75 years of age or older. Dispensation rates for 6 or more short-acting reliever inhalers (SABA) were 29.7% in patients 0 to 12 years of age, 70.3% in patients 12 to 18 years of age, 49.0% in patients18 to 75 years of age, and 37.2% in those 75 years of age or older. The inhalers were defined as a standardized SABA canister of a 150 doses recorded in the 12 months prior to death with no more than 2 SABA canisters considered appropriate use. They noted dispensation rates of 2 or more SABA canisters in 81.1% of patients 0 to 12 years of age, 92.6% of those 12 to 18 years of age, 68.2% of those 18 to 75 years of age, 55.2% of those 75 years of age or older.

Lung function tests were reported in 10.8% (0-12), 25.9% (12-18), 28.3% (18-75), and 18.6% (≥75) of patients in the 12 months prior to death. Investigators found 14.6% of patients (18-75) and 13.8% (≥75) visited a pulmonologist office, and less than 8% of adolescents and children visited a pulmonologist office in the 12 months prior to death. Emergency department visits were observed in 32.4% (0-12), 48.1% (12-18), 22.9% (18-75), and 22.9% (≥75) of patients in the 12 months prior to death.

Study limitations include the observational nature of the study and the risk of misdiagnosis of cause of death.

Investigators concluded that “Half of the patients who died from asthma had an inadequate ICS dose and only a small proportion had access to biological therapies in France.”  They noted the “Prescription of an adequate ICS dose, avoidance of premature discontinuation of ICS, education programs and referral to a specialist should be the focus of interest in order to achieve a significant reduction in asthma mortality.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.