Research in context
Evidence before this study
International trends in asthma mortality rates provide useful information about the burden of asthma and the impact of changes in asthma management. In this way, asthma mortality epidemics were identified in some but not all countries in the 1960s, 1970s, and 1980s. These epidemics were shown to be due to the overuse of the high-dose, potent, poorly selective β2 agonists isoprenaline forte and fenoterol, with the epidemics abruptly ending with their regulatory restriction or withdrawal. Since the 1980s there has been a marked increase in the use of inhaled corticosteroids (ICS) in the management of asthma. This change in management has been associated with a progressive two-thirds reduction in the estimated mean global asthma mortality rate between 1985 and 2005. On Oct 5, 2015, we searched MEDLINE with the terms “asthma” and “mortality” for publications in English published since 2009. This search revealed that international trends in asthma mortality over the past decade had not yet been reported.
Added value of this study
International trends in asthma mortality rates in the 5–34-year age group over the past decade are reported and analysed. Our analysis shows that estimated global asthma mortality rates in the 5–34-year age group have not appreciably changed over the past decade. Although in some countries and regions the asthma mortality rate has continued to fall, the estimated global asthma mortality rate has not changed since 2006. With 46 countries represented in our dataset, this is the most comprehensive analysis of international asthma mortality trends to date.
Implications of all the available evidence
The marked and progressive reduction in international asthma mortality rates observed since the late 1980s has plateaued, with no appreciable change in global asthma mortality rates since 2006. Although better implementation of established management strategies that have been shown to reduce mortality risk is needed, novel strategies will be required to achieve a further substantive reduction in global asthma mortality.