title: Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark.
abstract: BACKGROUND
  Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled asthma as a previous hospital admittance because of asthma (of any severity) or when asthma was considered to have influenced the death according to the death certificate. The purpose of this study is to increase the medical focus on young persons with uncontrolled asthma and thereby hopefully aid in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young persons with uncontrolled asthma.
  
  
  METHODS
  Through the review of death certificates, we found 625 sudden unexpected death cases in individuals aged 1-35 years in Denmark from 2000 to 2006. Of those, 49 persons with uncontrolled asthma were identified. Previous contacts with the healthcare system were identified, and available records from general practitioners were retrieved.
  
  
  RESULTS
  We identified 49 individuals who suffered from uncontrolled asthma. This corresponds to an incidence rate of 0.32 per 100,000 person-years. The cause of death in 31 cases (63%) was sudden cardiac death, and in 13 cases (27%), it was a fatal asthma attack. Symptoms (chest pain, dyspnea, seizures, general malaise, syncope, and palpitations) prior to death were reported in 41 (84%) of the cases. In 34 (69%) of the cases, antecedent symptoms (symptoms >24 hours before death) were present, and 28 (57%) patients had prodromal symptoms (symptoms <24 hours before death). The most common antecedent symptoms were dyspnea and chest pain, whereas the most common prodromal symptoms were dyspnea, general malaise, and/or fatigue. Twenty-eight patients (57%) sought medical advice from a general practitioner and/or emergency department due to these symptoms.
  
  
  CONCLUSIONS
  The cause of death was predominantly sudden cardiac death followed by fatal asthma attack. We found that 41 (84%) of patients suffered from symptoms prior to death and that 28 (57%) sought medical advice from the emergency department and/or general practitioners.
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. anders_gullach@hotmail.com.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. anders_gullach@hotmail.com.
authors.forename: Anders Juul
authors.initials: AJ
authors.lastname: Gullach
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. bjarkerisgaard@gmail.com.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. bjarkerisgaard@gmail.com.
authors.forename: Bjarke
authors.initials: B
authors.lastname: Risgaard
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. thomashadberglynge@gmail.com.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. thomashadberglynge@gmail.com.
authors.forename: Thomas Hadberg
authors.initials: TH
authors.lastname: Lynge
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. rezajabbari77@gmail.com.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. rezajabbari77@gmail.com.
authors.forename: Reza
authors.initials: R
authors.lastname: Jabbari
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. cglinge@gmail.com.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. cglinge@gmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Glinge
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. stig.haunsoe@regionh.dk.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. stig.haunsoe@regionh.dk.|Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark. stig.haunsoe@regionh.dk.
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.affiliation: Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. backer@dadlnet.dk.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. bowinkel@dadlnet.dk.|Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. bowinkel@dadlnet.dk.
authors.forename: Bo Gregers
authors.initials: BG
authors.lastname: Winkel
authors.affiliation: Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. tfelt@dadlnet.dk.|Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark. tfelt@dadlnet.dk.
authors.forename: Jacob
authors.initials: J
authors.lastname: Tfelt-Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000150:complications / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult