Prognosis:

About 1.8 million emergency room visits each year are due to asthma. The number of deaths from asthma increased from about 2,900 in 1908 to a high of 5,667 in 1996. The numbers appear to be declining slightly. In 2005, 3,884 people died because of asthma. Death from asthma is still a very uncommon event, considering that about 20 million people in the U.S. have this condition. Most deaths from asthma, even when they occur in elderly adults, are preventable. It is very rare for a person who is receiving proper treatment to die of asthma. And, studies suggest that the use of inhaled corticosteroids can reduce the risk for death by 90%. In spite of this and similar research, these important drugs are greatly underused.

Risk Factors for Very Severe or Fatal Asthma

About 55% of U.S. deaths from asthma occur among the elderly (over age 65), and an estimated 25% occur in adults aged 45 - 64. Women have a higher risk for fatal asthma than men. Being poor is also a significant risk factor for severe asthma. Hispanics and African-Americans are at higher risk for death from asthma than Caucasians. Other specific risk factors for fatal asthma include:

• Previous history of respiratory failure
• Frequent visits to the emergency room
• Lack of continuous care and poor compliance with medications
• Having stopped treatment, particularly withdrawal from corticosteroids
• Having an emotional or psychiatric disorder. (Some evidence suggests that depression, anxiety, and stressful life situations can worsen asthma.)
• Being a drug abuser
• Being in a lower socioeconomic and educational group

Degree of Severity

The severity of asthma is graded using the following categories: intermittent and mild, moderate, and severe persistent. A patient in any of these categories, even intermittent, can still have a severe and even life-threatening attack. In fact, according to one report, 30% of asthma deaths occur in patients with mild asthma.

Long-Term Outlook

Asthma is usually chronic, although it occasionally goes into long periods of remission. Long-term outlook generally depends on severity:

• In mild-to-moderate cases, asthma can improve over time, and many adults even become symptom free.
• Even in some severe cases, adults may experience improvement depending on the degree of obstruction in the lungs and the timeliness and effectiveness of treatment.
• In about 10% of severe persistent cases, changes in the structure of the walls of the airways lead to progressive and irreversible problems in lung function, even in aggressively treated patients.

Lung function declines faster than average in people with asthma, particularly in those who smoke and in those with excessive mucus production (an indicator of poor treatment control). Overall, one study reported that 72% of men and 86% of women with asthma had symptoms 15 years after an initial diagnosis. Only 19% of these people, however, were still seeing a doctor, and only 32% used any maintenance medication.

Patients who develop occupational asthma often have symptoms for years, even after avoiding the harmful triggers. Improvement does occur over time in most people who leave jobs that cause this problem.

Miscellaneous Complications or Associations

Emotional Problems. Even when it is not life threatening, asthma is debilitating and frightening. It significantly lowers the quality of life.

Sleep Disorders. Sleeplessness and daytime sleepiness are common problems.

Heart Disease. There have been some reports of an association between asthma and a heightened risk for heart disease. Some experts believe that the inflammatory process may be the common factor linking the two conditions, although there is no evidence to date confirming any causal association.