Skip to main content
Log in

Rise and fall of asthma-related mortality in Italy and sales of β2-agonists, 1980–1994

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

We performed this study with the aims of describing the trend of asthma-related mortality in Italy between 1980 and 1994, and to evaluate the relationship between sale estimates of β2-agonists drugs and mortality from asthma. For asthma mortality we used data provided by National Institute of Statistics, for sale estimates of β2-agonists we used data provided by IMS HEALTH. We calculated the gender specific age-standardized incidence rates of asthma-related deaths for all ages and for age classes. We found that estimates for asthma-related mortality steadily increased between 1980 and 1987 in both sexes, and thereafter decreased. In people, aged between 34 and 64 and over 64, death rates in males were significantly higher than in females while the rates in those aged less than 34, were mostly similar in both gender. The overall exposure to β2-agonists (alone and in combination) increased from 1980 to 1990, remained stable between 1990 and 1993, and increased steeply in 1994. We conclude that asthma-related death rates have declined since the mid-1980's. This decline has been more pronounced in males and in the older ages, while the rates in younger patients of both genders have remained nearly unchanged. Our data do not substantiate the hypothesis of an increased risk of asthma-related mortality associated to the use of inhaled β2-agonists in general nor fenoterol or salbutamol in particular.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Inman WHW, Adelstein AM. Rise and fall of asthma mortality in England and Wales in relation to use of pressurized aerosols. Lancet 1969; 2: 279–285.

    Google Scholar 

  2. Crane J, Pearce N, Flatt A, et al. Prescribed fenoterol and death from asthma in New Zealand, 1981–1983: Case-control study. Lancet 1989; 1: 917–922.

    Google Scholar 

  3. Spitzer WO, Suissa S, Ernst P, et al. The use of β-agonists and the risk of death and near death from asthma. N Engl J Med 1992; 326: 501–506.

    Google Scholar 

  4. Mullen M, Mullen B, Carey M. The association between β-agonist use and death from asthma. A metaanalytic integration of case-control studies. JAMA 1993; 270: 1842–1845.

    Google Scholar 

  5. Suissa S, Ernst P, Boivin JF, et al. A cohort analysis of excess mortality in asthma and the use of inhaled β-agonists. Am J Respir Crit Care Med 1994; 149: 604–610.

    Google Scholar 

  6. Suissa S, Blais L, Ernst P. Patterns of increasing use of β-agonist use and the risk of fatal or near-fatal asthma. Eur Respir J 1994; 7: 1602–1609.

    Google Scholar 

  7. Sears MR, Taylor DR. The β2-agonist controversy. Observations, explanations and relationship to asthma epidemiology. Drug Saf 1994; 11: 259–283.

    Google Scholar 

  8. Sly RM. Changing asthma mortality and sales of inhaled bronchodilators and anti-asthmatic drugs. Ann Allergy 1994; 73: 439–443.

    Google Scholar 

  9. Jackson RT, Beaglehole R, Rea HH, Sutherland DC. Mortality from asthma: A new epidemic in New Zealand. Br Med J 1982; 285: 771–774.

    Google Scholar 

  10. Burney PGJ. Asthma mortality in England and Wales: Evidence for a further increase, 1974–1984. Lancet 1988; 2: 323–326.

    Google Scholar 

  11. Cadet B, Robine JM, Leibovici D. Dynamics of asthma mortality in France: Seasonal fluctuations and peak mortality in 1985–1987. Rev Epidemiol Sante Publique 1994; 42: 103–118.

    Google Scholar 

  12. Cooreman J, Segala C, Henry C, Neukirch F. Trends in asthma-induced mortality in France from 1970–1990. Tuber Lung Dis 1994; 75: 182–187.

    Google Scholar 

  13. Juel K, Pedersen PA. Increasing asthma mortality in Denmark 1969–1988. Not because of changed coding practices. Ugeskr-Laeger 1993; 155: 3986–3988.

    Google Scholar 

  14. Center for Disease Control. Asthma-United States, 1982–1993. Morb Mortal Wkly Rep 1995; 43: 952–955.

    Google Scholar 

  15. Pearce N, Beasley R, Crane J, et al. End of the New Zealand asthma mortality epidemic. Lancet 1995; 345: 41–44.

    Google Scholar 

  16. Arrighi HM. US asthma mortality: 1941–1989. Ann Allergy Asthma Immunol 1995; 74: 321–326.

    Google Scholar 

  17. La Vecchia C, Fasoli M, Negri E, Tognoni G. Fall and rise in asthma mortality in Italy, 1968–1984. Int J Epidemiol 1989; 18: 998–999.

    Google Scholar 

  18. Mormile F, Chiappini F, Feola G, Ciappi G. Deaths from asthma in Italy (1974–1988): Is there a relationship with changing pharmacological approaches? J Clin Epidemiol 1996; 49: 1459–1466.

    Google Scholar 

  19. Fisher LD, Van Belle G. Biostatistics-A Methodology for the Health Sciences. New York: John Wiley & Sons Inc., 1993.

    Google Scholar 

  20. Gruppo di lavoro DURG-Italia. Caffari B, Di Giovambattista G, Cattaruzzi C, Mazzolani M, Vaccheri A. La lista delle DDD del DURG-Italia. Giornale Italiano di Farmacia Clinica 1995; 3: 130–131.

    Google Scholar 

  21. Breslow NE, Day NE. Statistical Methods in Cancer Research. Vol. 2. The design and analysis of cohort studies. Lyon: International Agency for Research on Cancer, 1987 (IARC Scientific Publication n. 82).

    Google Scholar 

  22. Burgess C, Pearce N, Thiruchelvam R, et al. Prescribed drug therapy and near-fatal asthma attacks. Eur Resp J 1994; 7: 498–503.

    Google Scholar 

  23. Grainger J, Woodman K, Perace N, et al. Prescribed fenoterol and death from asthma in New Zealand, 1981–1987: A further case-control study. Thorax 1991; 46: 105–111.

    Google Scholar 

  24. Pearce N, Grainger J, Atkinson M, et al. Case-control study of prescribed fenoterol and death from asthma in New Zealand, 1977–1981. Thorax 1990; 45: 170–175.

    Google Scholar 

  25. Suissa S, Ernst P. Optical illusions from visual data analysis: Example of the New Zealand asthma mortality epidemic. J Clin Epidemiol 1997; 50: 1079–1088.

    Google Scholar 

  26. Goldman M, Rachmiel M, Gendler L, Katz Y. Decrease in asthma mortality rate in Israel from 1991–1995: Is it related to increased use of inhaled corticosteroids? J Allergy Clin Immunol 2000; 105: 71–74.

    Google Scholar 

  27. Frischer M, Heatlie H, Chapman S, et al. Should the corticosteroid to bronchodilator ratio be promoted as a quality prescribed marker? Public Health 1999; 113: 247–225.

    Google Scholar 

  28. Bamfi F, Rizzini P, Festi D, et al. Comparison of anti-asthmatic drugs consumption among five european countries. 16th International Conference on Pharmacoepidemiology, 20–23 August, 2000, Barcelona, Spain.

  29. Lanes SF, Birmann B, Raiford D, Walker AM. International trends in sales of inhaled fenoterol, all inhaled ?-agonists, and asthma mortality, 1970–1992. J Clin Epidemiol 1997; 50: 321–328.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Romano, F., Recchia, G., Staniscia, T. et al. Rise and fall of asthma-related mortality in Italy and sales of β2-agonists, 1980–1994. Eur J Epidemiol 16, 783–787 (2000). https://doi.org/10.1023/A:1007644814153

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007644814153

Navigation