Two Studies Examine Death Records for Asthma Burden, Guideline Adherence by Providers

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Two recent studies examined issues related to asthma statistics and treatment: is mortality underrepresented due to how death certificates are recorded? How well do providers adhere to clinical guidelines for asthma?

Although many individuals around the world are able to live with asthma, approximately 420,000 people died from the respiratory disease worldwide in 2016. Asthma mortality rates are established from statistics and algorithms that identify the underlying cause of death (UCOD); however, asthma mortality based on UCOD underestimates disease burden.

A recent study analyzed asthma mortality in the United States from 1999 to 2015 using multiple-cause of death (MCOD) records. The researchers collected data from the CDC, including 156,517 death certificates that had any mention of asthma.1

During that same timeframe, a total of 59,067 deaths with UCOD of asthma were recorded, making up 37.7% of the deaths with any mention of asthma taken from the MCOD records. Of those, 37.3% females and 38.45% males.

In addition, among females, UCOD was 37.7% in Hispanics , 41.7% in blacks, and 36% in whites. For males, UCOD was 42.56% in Hispanics, 51.2% in blacks, and 52.1% in whites.


From 1999 to 2015, the age-adjusted MCOD death rates changed -38.1% for Hispanic females, -34.1% for black females, and -15.1% for white females. For men from 1999 to 2015, MCOD death rates changed -28.5% for Hispanic males, -21.3% for black males, and -25% for white males.

Black females and males had the highest MCOD and UCOD rates throughout the study period, according to the study.

“Among deaths with any mention of asthma, asthma was chosen as UCOD most often in black males and least often in white females. Age-adjusted MCOD rates declined most in white males and least in white females. The results show UCOD underestimated the burden of asthma mortality in the United States,” concluded the study. “We showed that asthma mortality using MCOD was 2.6 times higher when compared to UCOD.”

Another study used data from the 2012 National Asthma Survey of Physicians in order to compare self-reported guideline adherence by generalists and family medicine practitioners, internists, pediatricians, and community health center (CHC) mid-level clinicians.2 The study measured adherence to individual guideline recommendations through a questionnaire using a Likert scale with 1355 clinician respondents.

The results demonstrated that a higher percentage of pediatricians adhered to assessment and monitoring recommendations compared to other groups, with pediatricians almost always assessing daytime symptoms.

However, all groups had a low percentage for always assessing peak flow, performing spirometry, and repeatedly assessing inhaler technique.

“Adherence is moderate to high for some recommendations, was generally highest among pediatricians, and endorsement of inhaled corticosteroids for long term control was high for all groups of primary care clinicians,” concluded the authors. “However, adherence was low for key guideline recommendations including AAP provision, documentation of asthma control, and objective assessment and monitoring. High perceived self-efficacy was a strong and consistent predictor of adherence.”

Both studies were presented at The American Thoracic Society 2018 International Conference, San Diego, California.


1. Kodadhala V, Obi JI, Mehari A, Ogundipe T, Wessley P, Gillum R. Asthma-related mortality and co-morbidities in the United States of America, 1999-2015: a multiple causes of death analysis. Presented at the American Thoracic Society 2018 International Conference. May 20, 2018; San Diego, California. Abstract A1090.

2. Akinbami L, Salo PM, Cloutier MM, et al. Primary care clinician adherence with guidelines for the diagnosis and management of asthma: the national asthma survey of physicians. Presented at the American Thoracic Society 2018 International Conference. May 20, 2018; San Diego, California. Abstract A7644.