By Dr. Larry Chiaramonte
Dr. William Osler, one of the founders of American medicine as we know it (he started the tradition of the residency, among other things) once said, “An asthmatic will wheeze until old age.” He thought, I suppose, that while asthma caused suffering, it did not kill people. There was a lot of that in medicine in the nineteenth and early twentieth centuries. Doctors were more focused on preventing death than in treating chronic illness, which is a priority today. Anthony Shadid’s death from an asthma attack focuses attention on the fact that while asthma is sometimes fatal, it is now treatable.
Still, the old concentration on mortality has its contemporary echoes. In an article in Slate.com entitled “How Dangerous is Asthma?” Brian Palmer writes, “In 2010, 3,355 Americans died from asthma attacks 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. 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.”
Asthma mortality rates don’t truly measure the “danger.” For one thing, twenty-million Americans with asthma do not get to refrain from breathing the way swimmers have the option of staying out of the water, especially those who live in areas with high black-carbon content in the atmosphere like the neighborhood where I work. For another, the risks can be better measured in terms like these: “In the United States in 2007, there were 1.75 million (1.11 million for adults and 0.64 million for children) asthma-related emergency department visits and 456,000 (299,000 for adults and 157,000 for children) asthma-related hospitalizations.”
Any exacerbation severe enough to require a panicky trip to the hospital is one where a life is at risk—you don’t have to be under water to feel like you are drowning. Fortunately we have medicines that save most of these lives. But for each episode, there are many more days of lost productivity at school and work, and other measures of diminished quality of life, as well as billions of dollars in medical costs, pain and misery for patients, and their families. A low fatality rate is no justification for complacency, and it shouldn’t take the death of a celebrated journalist to focus attention on the problem. Fortunately, things have changed since Osler’s day. Modern medicine allows us to relieve suffering, treat the underlying inflammation, and save lives. It is estimated that 80% of asthma fatalities are preventable, and prevention doesn’t happen in the emergency room.