title: Fatal asthma; is it still an epidemic?
abstract: BACKGROUND
  Asthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors.
  
  
  METHODS
  A web search including key words related to fatal asthma in Italy between 2013 and 2015 has been performed. Concerning the cases that occurred in Veneto, subjects' clinical records have been evaluated and details about concomitant weather conditions, pollutants and pollen count have been collected.
  
  
  RESULTS
  Twenty-three cases of asthma deaths were found in Italy; 16 of them (69%) occurred in the Veneto Region. A prevalence of male and young age was observed. Most of patients were atopic, died in the night-time hours and during the weekends. The possible risk factors identified were the sensitization toalternaria, previous near fatal asthma attacks and the incorrect treatment of the disease. Weather condition did not appear to be related to the fatal exacerbations, whereas among the pollutants only ozone was detected over the accepted limits. Smoking habits, possible drug abuse and concomitant complementary therapies might be regarded as further risk factors.
  
  
  CONCLUSIONS
  Although not free from potential biases, our web search and further investigations highlight an increasing asthma mortality trend, similarly to what other observatories report. The analysis of available clinical data suggests that the lack of treatment more than a severe asthma phenotype characterizes the fatal events.
  
  
  CONCLUSIONS
  Asthma mortality still represents a critical issue in the management of the disease, particularly in youngsters. Once more the inadequate treatment and the lack of adherence seem to be not only related to the uncontrolled asthma but also to asthma mortality.
authors.affiliation: Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vianello
authors.affiliation: Asthma Center and Allergy Unit, Verona University and General Hospital, piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Caminati
authors.affiliation: Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy.
authors.forename: Mariangiola
authors.initials: M
authors.lastname: Crivellaro
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Rafi
authors.initials: R
authors.lastname: El Mazloum
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Snenghi
authors.affiliation: Asthma Center and Allergy Unit, Verona University and General Hospital, piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Schiappoli
authors.affiliation: Asthma Center and Allergy Unit, Verona University and General Hospital, piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Dama
authors.affiliation: Asthma Center and Allergy Unit, Verona University and General Hospital, piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Asthma Center and Allergy Unit, Verona University and General Hospital, piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Festi
authors.affiliation: Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy.
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Marchi
authors.affiliation: Medical Direction, Verona University and General Hospital, Verona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bovo
authors.affiliation: Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Giorgio Walter
authors.initials: GW
authors.lastname: Canonica
authors.affiliation: Asthma Center and Allergy Unit, Verona University and General Hospital, piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Gianenrico
authors.initials: G
authors.lastname: Senna
keywords: Alternaria; Asthma exacerbations; Asthma mortality; Fatal asthma