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Mortality and disease burden in the North-West England severe asthma population

Introduction: Cause of death and morbidity in severe asthma patients has not been studied since 2014 (1). Oral corticosteroid (OCS) burden should be considered in the context of biological therapy licensing for severe eosinophilic asthma. Aims: To understand cause of death and the effect of treatments on mortality and morbidity in severe asthma patients in North-West England since 2014. Methods: Patients included were under the severe asthma service and died between May 2014 and June 2017. Data was collected from clinical notes, databases and Coroner’s reports. Pre-designated categories guided data collection, including disease, cause of death, demographics, and treatments. Results: Of 46 patients, 24 were female. Causes of death were known for 35. Asthma caused 2 deaths (5.7%), cardiovascular caused 13 (37.1%) and neoplasms 8 (22.9%). Mean inhaled corticosteroid (ICS) dose was 1599 mcg/day. OCS were used by 32 patients (73.9%), with OCS-induced diseases expressed by 32 patients (69.6%). Mean OCS dose was 19 mg. Positive eosinophil counts were expressed by 17 patients (37.0%) 12 months before death, and 35 patients (76.1%) in their lifetime. Conclusion: Our data showed a minimal incidence of asthma-attributed deaths (5.4%) but a greater proportion of patients on OCS than prior studies. Severe asthma patients had a high incidence of OCS-induced disease, including obesity and diabetes. Cardiovascular causes accounted for majority of deaths. Biological therapies could improve the morbidity and mortality of severe asthma patients in North-West England as steroid-sparing agents. Reference: 1. Sullivan J, O’Shea K, Mansur A. P78 Study of mortality in severe and difficult to treat asthma. Thorax. 2015;70(Suppl 3):A114.2-A115.