title: Risk factors for death from asthma. Prairie Provinces Asthma Study Group.
abstract: BACKGROUND
  Asthma mortality rates have increased in Canada and worldwide. Within Canada, the highest rates were seen in the prairie provinces.
  
  
  OBJECTIVE
  The objective was to determine risk factors for fatal asthma by comparing those who died of an acute exacerbation with those who attended an emergency department for treatment of asthma.
  
  
  METHODS
  The case-control study included all deaths from asthma among those aged 5 to 50 years in Alberta, Saskatchewan and Manitoba from November, 1992 through October, 1995 (cases). The 35 fatalities were matched to 209 controls by age, gender, time of the index event and residence.
  
  
  RESULTS
  Cases were more likely than controls to have had severe asthma, an unscheduled physician visit in the past year, a past hospitalization for asthma, and to have been intubated. Both groups reported frequent, regular asthma symptoms. Beta-agonist bronchodilator use was more common among cases, as was use in excess of prescribed amounts. Use of inhaled steroids did not differ between groups. Prior to the index event controls were more likely to report a cold or flu (OR = 0.27; 95% CI: 0.10 to 0.72) and that medications were "not working" (OR = 0.30; 95% CI: 0.12 to 0.71). Cases were more often sad and depressed (OR = 2.88; 95% CI: 1.03 to 8.05). Time between onset/recognition of symptoms and the event was significantly shorter for cases than controls.
  
  
  CONCLUSIONS
  Both groups tolerated high levels of regular symptoms, suggesting poor management. Opportunities for intervention existed for both groups near the time of the event. The short time between recognition of symptoms and death suggests patients at increased risk should monitor their condition closely and take action in response to predetermined criteria.
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Canada. pat.hessel@ualberta.ca
authors.forename: P A
authors.initials: PA
authors.lastname: Hessel
authors.forename: I
authors.initials: I
authors.lastname: Mitchell
authors.forename: S
authors.initials: S
authors.lastname: Tough
authors.forename: F H
authors.initials: FH
authors.lastname: Green
authors.forename: D
authors.initials: D
authors.lastname: Cockcroft
authors.forename: W
authors.initials: W
authors.lastname: Kepron
authors.forename: J C
authors.initials: JC
authors.lastname: Butt
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D001344:Autopsy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002170:Canada; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents