Asthma mortality: the worldwide response

All over the world, but especially in western countries, there has been a rise in asthma mortality. Air pollution, increasing concentrations of house dust mite allergen, poverty, limited access to adequate medical care among urban minorities, inappropriate use of Pz-adrenergic agonists and underutilization of disease-modifying antiinflammatory therapies have been among the most frequently postulated causes for this worrisome trend(1-4). This has occurred despite continued gains in our understanding of the underlying inflammatory nature of this disease. Indeed, increasing asthma mortality is a paradox, since the mortality of all other non-malignant chronic illnesses has declined with advances in understanding and treatment(5). Table 1 makes some international comparisons for the year 1980. During the past 10 years many countries have begun to fight back against the rising tide of asthma deaths. The barriers that limit an asthmatic's access to urgent health care, therapeutic drugs, and preventive measures all stem from an individual source-namely, lack of adequate patient, family and health-professional education. In this paper we focus on the predicament of their response and the progress they have made.