Case-control study of severe life threatening asthma (SLTA) in a developing community

• Published in: Thorax Vol. 61; no. 9; pp. 756 - 760
• Main Authors: van der Merwe, L, de Klerk, A, Kidd, M, Bardin, P G, van Schalkwyk, E M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.09.2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: acute attack; Adult; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - epidemiology; Asthma - physiopathology; Biological and medical sciences; Case-Control Studies; Chronic obstructive pulmonary disease, asthma; Developing Countries; Emergency medical care; Fatalities; Female; FEV1; forced expiratory volume in 1 second; forced vital capacity; FVC; health care; Humans; ICU; intensive care unit; LDCs; Male; Medical sciences; Mortality; Pneumology; Respiratory Function Tests; Risk Factors; severe life threatening asthma; SLTA; South Africa - epidemiology; Studies; South Africa; Africa; Lung disease; Respiratory disease; Bronchus disease; Cardiovascular disease; Obstructive pulmonary disease; Case control study; Severe; Community; Asthma
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.2005.052308

Background: Distinct risk factors for asthma death have not been identified in developing communities. This study was conducted to distinguish risk factors for severe life threatening asthma (SLTA), a proxy for asthma death, in a developing country. Methods: A case-control study was performed at a University Hospital serving developing communities in the Western Cape Province, South Africa, over the period October 1997 to April 2000. Thirty consecutive patients with SLTA admitted to the intensive care unit (ICU) were compared with 60 chronic asthmatic patients, without a history of SLTA, who had attended the hospital outpatient respiratory clinic over the same period. Results: The risk of SLTA in comparison with controls increased with female sex (odds ratio (OR) 3.3, 95% CI 1.2 to 9.6, p = 0.02), rural residence (OR 8.1, 95% CI 2.6 to 25.3, p = 0.0005), and absence of a formal income (OR 5.7, 95% CI 2 to 16.6, p = 0.002). Cases were more likely to have had more than one hospital admission in the previous year (OR 8, 95% CI 2.5 to 25.2, p = 0.0009) and more than one emergency room visit in the previous year (OR 4.4, 95% CI 1.19 to 16.4, p = 0.04). Patients with SLTA were less likely to use inhaled corticosteroids (OR 5.6, 95% CI 1.9 to 16.5, p = 0.003) and more likely to use inhaled fenoterol (OR 6, 95% CI 2.2 to 16.2, p = 0.0004). Patients with SLTA also had lower mean (SE) forced expiratory volume in 1 second (FEV1) measurements (66.9 (9.5)% predicted v 82.5 (4.0)% predicted; p = 0.03) and lower FEV1/FVC ratios (60.7 (4.1)% predicted v 69.6 (1.9)% predicted; p = 0.05) documented before the episode of SLTA. Conclusions: Risk factors for SLTA that are mainly analogous to those distinguished in other environments have been identified in a geographical area characterised by a third world socioeconomic context. Rural residence and poverty may increase the risk of SLTA.