New York Times reporter Anthony Shadid died on Thursday while covering the unrest in Syria. He apparently had an allergic reaction to a horse and succumbed to an asthma attack. How dangerous is asthma?
It’s rarely fatal, if you have access to health care. In 2010, 3,355 Americans died from asthma attacks (PDF), for an age-adjusted death rate of one person per 100,000 population. That’s a fairly low rate, especially considering how widespread the disease is. About 20 million Americans suffer from asthma, placing it in the top 10 chronic diseases by prevalence. To put the fatalities into perspective, the death rate for asthma is far lower than the death rate for accidental poisoning (9.9 deaths per 100,000 population) or alcohol-induced fatalities (7.5), and slightly lower than the death rate for accidental drownings (1.2) and workplace injuries (1.6). Among natural causes of death, asthma has about the same population-wide death rate as laryngeal cancer.
Eighty percent of asthma fatalities could have been prevented with ordinary medical treatment in the form of long-term control medications or emergency interventions like nebulizers or intravenous drugs. In many such cases, the victim is a child who fails to take his medicine properly. Adults may succumb to an asthma attack if they forget to carry an inhaler or nebulizer and are unable to get to a hospital quickly. The remaining 20 percent of fatalities involve severe asthmatics who don’t respond to treatment or can’t take any of the common medications due to adverse drug reactions. Among this group, exposure to allergens can easily be fatal. Animal allergies cause particularly severe reactions, as they seem to have in the case of Anthony Shadid.
Asthma fatality rates rise and fall over time for various reasons. There was a sharp spike in deaths among asthmatics in Great Britain and New Zealand during the 1950s and 1960s, which has since been linked to broad spectrum medications that damaged the hearts of sensitive patients. From the 1970s to the late 1990s, there was an increase in both asthma cases and fatalities in the United States. In 1998, the fatality rate reached two deaths per 100,000 population, twice what it is now. Most experts believe lifestyle changes caused the surge—more time spent indoors, increased exposure to allergens and dust mites, and possibly an uptick in the inhalation of airborne pollutants. As concern over asthma grew, asthma treatments improved, emergency rooms got better at dealing with asthma attacks, and the death rate began to decline.
We’ve come a long way in terms of asthma awareness. Until the 20th century, many people believed that asthma was never fatal. This misconception—coupled with the fact that asthma in the poorer classes was often misdiagnosed as bronchitis—helped to make asthma a fashionable disease of the 19th century. Prominent intellectuals like Marcel Proust were emblematic of the disease, and Europeans came to think of asthma as the mark of good breeding and intellectual superiority. Many went to their doctor hoping for an asthma diagnosis, along with other modish diseases like hay fever, gout, and tuberculosis.
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Explainer thanks Mark Jackson of the University of Exeter and author of Asthma: the Biography.