Writing in the monthly peer-reviewed journal of the American Thoracic Society, Michael J. Abramson, Ph.D., of the Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia, together with seven colleagues, examined data on 89 asthma deaths, while studying the records of 229 control patients.

The controls were individuals with acute severe asthma who required bronchodilators during emergency department visits to four participating hospitals.

The asthma death cases, which occurred from 1994 to 1996, were identified through the Victoria governmental vital statistics registry.

During the 1980s, Australia and New Zealand experienced more deaths from asthma than any other countries in the world. In Australia, the death rate from asthma in 1989 rose to almost six persons (5.8) per year per 100,000 population, a rate which fell to three individuals per year per 100,000 by 1996.

After examining the asthma deaths and near-fatal attacks, various studies concluded that inadequate assessment and/or therapy, no regular medical care, poor adherence to therapy, delay in seeking and receiving care, and inadequate treatment were all preventable factors involved in the fatal outcomes.

Developed in 1989, the Australian Asthma Management Plan advised physicians to regularly assess asthma severity in an attempt to achieve the best possible lung function.

To maintain such function, doctors should help patients avoid disease trigger factors, optimize use of their medications, develop an asthma action plan, educate themselves about their disease, and review their medical status regularly. The system advocated a written self-management plan, self-monitoring of peak flow with a meter, and regular review of asthma status by a physician.

Between 1990 and 1993, the proportion of patients with both an action plan and peak flow meter use increased significantly, according to the paper.

In their study, the researchers found that a written asthma action plan could reduce the risk of death significantly, as well as seriously reduce hospitalization rates.

They also found that patients who died were significantly less likely than control patients to use oral steroids for attacks of asthma. In addition, they discovered that their results were consistent with a meta-analysis that showed early use of systemic steroids in an acute asthma attack reduced the need for hospital admission and prevented relapse.

In an editorial discussing the study, also in the January issue, Richard Beasley, M.D., and Julian Crane, of the Department of Medicine, Wellington School of Medicine, Wellington, New Zealand, wrote:

"Most self-management plans are based on regular long-term use of inhaled corticosteroid therapy in association with the use of oral corticosteroids for major exacerbations. Inhaled agonists represent the bronchodilator drugs of choice, used as required to relieve symptoms, and with an increased requirement, or a poor or short duration of response, indicating worsening asthma."

The editorial notes that this study provided further evidence of asthma self-management plans, which involve a written action plan, self-monitoring of peak flow and interpretation of key symptoms, in association with regular physician review, represented "optimal" management and should be offered to most adults with the disease. - By Lori Quigley

Related website:

American Thoracic Society Journals Online

[Contact: Michael Abramson Ph.D., Lori Quigley]

18-Jan-2001