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INTRODUCTION
Asthma is a chronic and worldwide
disease affecting people of all ages. Its
mortality remained relatively stable for
the 100 years preceding the 1960s
when "epidemics of death" began in
New Zealand, Australia, and the UK,I,2
and were associated in time with the
introduction of high dose isoprenaline
(isopraterenol) spray.3 Another peak of
asthma deaths occurred in the late
1970s, again in New Zealand, and simultaneous with the widespread usage
of another beta-agonist, fenotero1.4.5
Since 1977, reports fram the UK, Denmark, France, Canada, West Germany,
and the United States have shown increases in asthma mortality.6.7In contrast, in Japan, although rates of death
from asthma were higher than those in
From the Institute of Immunological Research. The Univc:rsity of Cartagena. Cartagena,
Colombia.
Received for publication December 2, 1996.
Accepted for publication in revised form May
9.1997.
55
RESULTS
Trend of Asthma Mortality in
Colombia
Asthma was the cause in 10,938 deaths
in the time period studied. Five hundred and nine occurred in 1979 with
successive increases until 942 were
reached in 1985. In 1986, 781 deaths
occurred, 806 in 1987. and 764 in
1988. Values vaned during the subsequent years uudl t 994. when 568
deaths were reported.
Death rates had a similar pttern. In
1979 the rate of death was 2.06 per
100,000 which rose to 3.15 in 1985
and decreased to 1.6 in 1994 (Fig 1).
When asthma death rates of aIl ages
were considered, a decreasing trend
with a variation coefficient of 1.09%
per year was observed. An average of
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would have preval1ed if the age-specific rates for each year had occurred
in a population with the same age distribution as that of Colombia in 1973.
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year
Figure 1. Asthma death rates per 100,000 genera] population
56
in Colombia,
]979 to ]994.
ANNALS
OF ALLERGY.
ASTHMA.
& IMMUNOLOGY
1000
'"
900
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.s
/ \
800
700
,/
13
.S
600
500
..
;
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.:;
..,
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400
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--- /
......
300
200
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om
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year
-+-
5-34years
-.- al!ages
..
deaths due lo asthma in 1978 and earlier to evaluate this possibility. Overall, rates of death from asthma were
similar in both sexes. We did not anaIyze death from aslhma by race or poverty because these data were not registered in the death certificates.
Places 01 Death
Asthma mortality at home was more
frequent (62.2%) than in hospitals
(31.0%); 3.4% of deaths occurred in
other places and in 3.3% the place of
death was not specified. Overall,
deaths at home were twice to three
times more frequent than those occurring at hospitals. Furtherrnore, deaths
at home dropped from 73.6% in 1979
to 44% in 1994, when a simultaneous
increase in deaths occurred in hospitals
(25.2% 1050.3%). In this lime periodo
certificates that did not register the
-->34 years
---*-< 5years
by age groups.
1919 10 1994.
51
Urban
Non-specified
Year
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
Total
ilsthma
No
No
No
372
482
530
519
601
595
708
578
603
606
452
480
448
462
526
498
8460
73.5
71.5
73.4
74.5
78.9
76.8
74.7
74.0
74.9
79.3
76.5
76.7
80.1
86.8
83.4
87.6
77.3
135
192
192
178
161
175
227
194
200
156
134
136
104
69
98
65
2416
26.5
28.5
26.6
25.5
21.1
25.6
23.9
24.9
24.8
20.4
22.6
21.7
18.6
12.9
15.5
11.4
22.1
O
O
O
O
O
5
7
9
3
2
5
10
7
1
6
5
60
0.0
0.0
0.0
0.0
0.0
0.6
0.7
1.2
0.3
0.3
0.8
1.6
1.3
0.2
0.9
0.8
0.5
in Colombia
and
three
other
countries.
Although in many countries an increase in asthma deaths has been re-
....
..
---
BRAZIL
-fr-
USA
--New
Zealand
--Colombia
6
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ti
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!S
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;:
...
o.
1960
1962
1964
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
year
Figure 3. Asthma mortalily
""
ANNALS
1994.10.21.31
OF ALLERGY.
ASTHMA.
& IMMUNOLOGY
.
descending trend when rates were estlmated in the ase sroup of 5 10 34
years, for whom eertifieation of
aSlhma as a cause of dealh can be more
reliable than in people older than 35
years."
Asthma mortality depends on the
global management of the disease.
During the last 10 years ehanges in
publie health policies lo improve Ihe
delivery of heallh eare have been made
in Colombia. This could be eausing the
deereasing trehd of asthma mortality,
but we do not have data from the evaluation of the health eare stratesies to
confirm its effeets on this particular
disease. Desilninl .tudies to anal)'ze
this and other eonditlons that can affeet
the mortalily from asthma in this eountry is neeessary.
For example, it seems that melered
dose inhaler beta-2-agonists are not
widely used in Colombia. mainly because of their priee. In eontrast, oral
corticosteroids,
especially
prednisolone, are eommonly used, even
wilhout medieal preseription. AIthough these two aspeets of aSlhma
treatmenl can inlluenee the Irend of
monality. Ihey are nol seienlifically
documented in Ihis eounlry.
In addilion. Ihe effeet of ehanges in
aslhma prevalenee in Colombia on our
results eannot be evalualed beeause
sludies of aSlhma prevalenee and ils
lrend al a national level are not available. Aeeording lo one investigalion
from a Caribbean city of Colombia.
asthma prevalenee in 1990 was higher
than in other Latin American cities,24
but several climale and racial differenees exisl within the eountry Ihal
make it diffieult to extrapolate these
data to other cities.
We found that Ihe higher rates of
deaths from asthma were in subjeets
older than 35 years of age. As mentioned earlier. it appears thal this age
group drives the trend, possibly affeeting the reliabilily of the dala. Age adjustment of deaths from aSlhma was
done to eorreet for faelors inllueneing
age distribulion of Ihe population, for
inslanee. aging, and the resuits also
showed a deereasing trend. So, it
seems thal the higher asthma mortality
59
. -, .
,
8nd treatment. Ottowa; Humana Press,
1994:1-22.
15. Livne M. Weissgarten J. Stav D. et al.
Althma mortalit~ in IsraeI1971-1990.
Ann Allergy Aschma Immunol 1996;
76:261-5.
16. Sol D. Salto J. Naspitz C. Editorial:
Mortalidade por asma br6nquica no
Brasil e no estado e munfcipio de Sao
Paulo. J PneumaI1995:21:XV..XVI.
17. Batule M. Garcia O. Toledo H. VidailIet J. Mortalidad por asma bronquial y
relacin con condiciones ambientales
atmosfricas en Ciudad de la Habana.
Rev Cub Med 1990;29:473-84.
18. Can seco C. Gonzalez S. Alvarado C.
Mortalidad por 811maen el estado de
Nuevo Le6n, Mxico. Alergia Mx
1993;40: 119-23.
19. Baena C. Salvucci K. Jalil E. et al.
Estudio de la Mortalidad por asma en
la provincia de Crdoba entre 1980 y
1991. Arch Argent Alergia Inmunol
Clin 1994;26:91-9.
20. Neffen H. Baena C, Malka S. et al.
Asthma mortality in Latin America.
"
21.
28.
29.
30.
31.
/'
60