Continúa descendiendo la mortalidad por asma en Uruguay: Período 1984-2008

Juan Carlos Baluga; Adriana Sueta; Martha Ceni

Authors

Juan Carlos Baluga Ministerio de Salud Pública, Centro Hospitalario Pereira Rossell, Servicio de Alergia y Asma Infantil, Jefe. Pediatra Alergista
Adriana Sueta Ministerio de Salud Pública, Centro Hospitalario Pereira Rossell, Servicio de Alergia y Asma Infantil. Pediatra Alergista
Martha Ceni Ministerio de Salud Pública, Centro Hospitalario Pereira Rossell, Servicio de Alergia y Asma Infantil. Pediatra Alergista

Keywords:

ASTHMA, MORTALITY, URUGUAY

Abstract

Introduction: asthma mortality has varied throughout time, there being two epidemic peaks in the 60s and 70s, and then gradually increase until the late eighties, followed by a period where figures were stable, and subsequently dropping in several countries.
Objectives: to conduct a report on the asthma mortality rates in Uruguay, its changes and trends, or a 25 year period between 1984 and 2008. To relate the trends followed by such rates with the sale of inhaled corticoids on its own and associated with long duration ß2 de larga duración (ß2LD).
Method: we conducted a retrospective epidemiological study with the purpose of assessing global and specific mortality rates (0-19, 5-34 and over 60 years old). The data to used to calculate the above mentioned rates were taken from the Statistics Department of the Ministry of Health and the National Statistics Institute, and the pharmaceutical products anti-asthma drug sales in the International Market Survey Report (IMS). Trends in mortality rates were analyzed by linear regression and the Spearman correlation was used to relate mortality rates with inhaled corticoids.
Results: 5-34 and over 60 years old showed a decreasing tendency in global mortality rates during the period studied (p=0,0001, p=0,0001 and p=0,02, respectively).
The highest global mortality rate was observed in 1987 (185 cases, 6.08 rate), and the lowest rate was observed in 2008 (78 deaths, 2.33 rate), decreasing 61.7% during the period studied. 5-35 years old mortality rates has a peak in 1986 and 1991 (0.62 rate) and its lowest value was observed in 2002 and 2005 (0.06). Average mortality was 0.17 in the last five years.
We proved a statistically meaningful inverse correlation (Rho –0,84, p=0,0001) between IC sales (administered on their own or associated to ß2LD) and the decrease of mortality.
Conclusions: asthma mortality rates have decreased in the last years, following a tendency that started in the eighties. The 5-34 years old group rates, considered to be the least reliable, are comparatively lower than average rates in those countries where recent publication on the topic are available. This decrease is correlated with the increase in the sale of IC, on its own or associated to ß2LD.

References

(1) Masoli M, Fabian D, Holt S, Beasley R; Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy 2004; 59(5): 469-78.
(2) Sly RM. Optimal management improves asthma morbidity and mortality. Ann Allergy Asthma Immunol 2003; 90(1): 10-2.
(3) Beasley R. A historical perspective of the New Zealand asthma mortality epidemics. J Allergy Clin Immunol 2006; 117(1): 225-8.
(4) Beasley R, Pearce N, Crane J, Burgess C. Beta-agonists: what is the evidence that their use increase the risk of asthma morbidity and mortality? J Allergy Clin Immunol 1999; 104(2 Pt 2): S18-30.
(5) Crane J, Pearce N, Flatt A, Burgess C, Jackson R, Kwong T, et al. Prescribed fenoterol and death from asthma in New Zealand, 1981-1983: case-control study. Lancet 1989; 1(8644): 917-22.
(6) National Institute of Health. National Heart, Lung, Blood Institute. Global strategy for asthma management and prevention. NHLBI/ WHO Workshop report (Publication number 95-3659, January) 1995: 13-6.
(7) Sánchez-Bahíllo M, García-Marcos L, Pérez-Fernández V, Martínez-Torres AE, Sánchez-Solís M. Trends in asthma mortality in Spain from 1960 to 2005. Arch Bronconeumol 2009; 45(3): 123-8.
(8) Chatkin G, Chatkin JM, Fritscher CC, Cavalet-Blanco D, Bittencourt HR, Sears MR. Asthma mortality in southern Brazil: is there a changing trend? J Asthma 2007; 44(2): 133-6.
(9) Tual S, Godard P, Piau JP, Bousquet J, Annesi-Maesano I. Asthma-related mortality in France, 1980-2005: decline since the last decade. Allergy 2008; 63(5): 621-3.
(10) Baluga JC, Sueta A, Ceni M. Asthma mortality in Uruguay: 1984-1998. Ann Allergy Asthma Immunol 2001; 87(2): 124-8.
(11) Sly RM. Continuing decreases in asthma mortality in the United States. Ann Allergy Asthma Immunol 2004; 92(3): 313-8.
(12) Bergström SE, Boman G, Eriksson L, Formgren H, Foucard T, Hörte LG, et al. Asthma mortality among Swedish children and young adults, a 10-year study. Respir Med 2008; 102(9): 1335-41.
(13) López-Campos JL, Cayuela A, Rodríguez-Domínguez S, Vigil E. Temporal trends in asthma mortality over 30 years. J Asthma 2008; 45(7): 611-14.
(14) Sly RM. Decreases in Hispanic an non-Hispanic asthma mortality. Ann Allergy Asthma Immunol 2006; 96(1): 76-9.
(15) Suissa S, Ernst P. Inhaled corticosteroids: impact on asthma morbidity and mortality. J Allergy Clin Immunol 2001; 107(6): 937-44.
(16) Nunes de Melo M, Mendes Z, Martins P, Suissa S. Asthma mortality in Portugal: impact of treatment with inhaled corticosteroids and leukotriene receptor antagonists. Treat Respir Med 2006; 5(2): 143-7.
(17) Baluga JC, Sueta A, Ceni M. Tendencia de la mortalidad por asma en Uruguay 1984-2001: relación con la venta de medicamentos antiasmáticos. Rev Med Urug 2003; 19(2): 117-25.
(18) Accuracy of death certificates in bronchial asthma. Accuracy of certification procedures during the confidential inquiry by the British Thoracic Association. A subcommittee of the BTA Research Committee. Thorax 1984; 39(7): 505-9.
(19) Sears MR, Rea HH, de Boer G, Beaglehole R, Gillies AJ, Holst PE, et al.Accuracy of certification of deaths due to asthma. A national study. Am J Epidemiol 1986; 124(6): 1004-11.
(20) Wijesinghe M, Weatherall M, Perrin K, Crane J, Beasley R. International trends in asthma mortality rates in the 5- to 34-year age group. Chest 2009; 135(4): 1045-9.
(21) Stupka E, deShazo R. Asthma in seniors: Part 1. Evidence for underdiagnosis, undertreatment, and increasing morbidity and mortality. Am J Med 2009; 122(1): 6-11.
(22) Inman WH, Adelstein AM. Rise and fall of asthma mortality in England and Wales in relation to use of pressurized aerosols. Lancet 1969; 2(761): 279-85.
(23) Beasley R, Pearce N, Crane J. Wordwide trends in asthma mortality during the twentieth century. In: Lenfant C, Sheffer A, eds. Fatal asthma, lung biology in health disease series. New York: Marcel Decker, 1998: 13-30.
(24) Rodríguez-Trigo G, Plaza V, Picado C, Sanchis J. Management according to the Global Initiative for Asthma guidelines of patients with near-fatal asthma reduces morbidity and mortality. Arch Bronconeumol 2008; 44(4): 192-6.
(25) Gomez Dinger PL, Kaplan MS, Goldberg BJ, Staveren AM, Hsu JY. The relationship of long acting beta agonists to asthma mortality. J Allergy Clin Immunol 2008; 121(2 Suppl 1): S142.
(26) Drazen JM, O’Byrne PM. Risks of long-acting beta-agonists in achieving asthma control. N Engl J Med 2009; 360(16): 1671-2.
(27) National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol 2007; 120(5 Suppl): S94-138.
(28) Chatenoud L, Malvezzi M, Pitrelli A, La Vecchia C, Bamfi F. Asthma mortality and long-acting beta2-agonists in five major European countries, 1994-2004. J Asthma 2009; 46(6): 546-51.