Multinational cohort study of mortality in patients with asthma and severe asthma

Respir Med. 2020 Apr-May;165:105919. doi: 10.1016/j.rmed.2020.105919. Epub 2020 Mar 2.


Background: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma.

Methods: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma.

Results: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality.

Conclusion: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.

Keywords: Asthma epidemiology; Cohort studies; Mortality; Severe asthma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones
  • Age Factors
  • Asthma / mortality*
  • Cause of Death
  • Cohort Studies
  • Comorbidity
  • Disease Progression
  • Drug Utilization
  • Emergency Service, Hospital / statistics & numerical data
  • Europe / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Severity of Illness Index
  • Sex Factors
  • Smoking / adverse effects


  • Adrenal Cortex Hormones