© 2007 American Thoracic Society
Asthma Mortality in Michigan for the Years 2002 to 2005, Ages 5–34To the EditorKrishnan and colleagues, in their recent article on mortality in hospitalized patients with asthma exacerbations, report that the majority (67%) of asthma deaths occur outside of the hospital and "that improvements in the management of asthma exacerbations before hospitalization will have the greatest benefit" (1). What the authors don't report is that this finding varies by age group and is even more striking for individuals dying between the ages of 5 and 34 years. We have been conducting a surveillance program for the State of Michigan funded by the Centers for Disease Control and Prevention (CDC) in conjunction with the Michigan Department of Community Health (http://www.getasthmahelp.org/reports.asp). For the Years 2002–2005, asthma was the underlying cause of death in 110 Michigan residents who died between the ages of 5 and 34. The surveillance system consists of conducting an interview with a next-of-kin and reviewing the following records when they exist: autopsy report, medical records from the time of death and the year prior to death, and ambulance/police records from the time of death. From 2002 to 2005, 15 of the 110 patients with asthma in Michigan who died were admitted to the hospital. This is only 14% of the deaths. Patients' respiratory/cardiac arrest occurred prior to arrival of emergency personnel on the scene. Of the 15 patients admitted to the hospital, only 5 were conscious at the time emergency responders picked them up, and only 3 were conscious at the time of admission to the hospital from the emergency room. If national findings for the younger-than-35 age group (the group most likely to be correctly diagnosed with asthma) are the same as in Michigan, it would emphasize the conclusion of Krishnan and coworkers "that improvements in management of asthma exacerbation before hospitalization will have the greatest benefit" (1). Additional information that we have been able to gather would indicate that improvements are needed prior to transportation to the hospital. On the other hand, the percentage of in-hospital asthma deaths for at least some of the older age categories would be expected to be greater than the overall 33 to 34% found for all age groups combined as reported by Krishnan and coworkers (1). Examination of these percentages by age may assist in better targeting interventions.
Michigan State University East Lansing, Michigan FOOTNOTES Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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