Mortality in Severe Asthma

<bold>Background:</bold> Longitudinal data examining the impact of asthma severity on mortality are lacking. In this study, we aimed to explore all-cause and cause-specific mortality according to asthma severity. <bold>Methods:</bold> This prospective observational cohort study is based on Danish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research platform. Adult patients with severe asthma were matched on age and sex to 10 patients with mild-to-moderate asthma and followed from 2000-2020. Patients with COPD diagnosed prior to inclusion were excluded. Absolute and relative measures of risks of all-cause and cause-specific mortality were compared between severe and mild-to-moderate asthma. <bold>Results:</bold> We included 11,811 and 118,810 patients with severe and mild-to-moderate asthma, respectively. All-cause mortality was significantly higher in patients with severe asthma compared to patients with mild-to-moderate asthma, both in absolute measures of the cumulative mortality [34% (CI 95%: 32, 35) vs 20% (19, 20), p<0.001] after 20 years of follow-up and in relative measures [hazard ratio (HR)=1.99 (1.90, 2.09), p<0.001]. The HR of all-cause mortality was attenuated after adjustment for T2 inflammatory markers [HR 1.34 (95CI%: 1.09, 1.64)]. The leading causes of death in both groups were respiratory diseases, neoplasms, and cardiovascular diseases. When excluding patients who developed COPD during follow-up, the increased mortality risk in severe asthma patients remained significant. <bold>Conclusion:</bold> This prospective study revealed a significant excess mortality in patients with severe asthma compared to patients with mild to moderate asthma. This was primarily driven by respiratory-related deaths, and with T2 inflammation as a potential contributing mortality risk factor.

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Publication Details

Journal
Epidemiology
Published
2025-09-27
DOI
https://doi.org/10.1183/13993003.congress-2025.pa2610
Primary Topic
Asthma and respiratory diseases
Type
article
Field-Weighted Citation Impact
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article

Mortality in Severe Asthma

Asger Sverrild, Anna von Bülow, Olivia Ernstsson, Patrik Sandin et al.
Epidemiology
Asthma and respiratory diseases
article

Mortality in Severe Asthma

Asger Sverrild, Anna von Bülow, Olivia Ernstsson, Patrik Sandin, Helena Bäckman, Christer Janson, Jussi Karjalainen, Hannu Kankaanranta, Alan Altraja, Paula Kauppi, Susanne Hansen, Apostolos Bossios, Charlotte Suppli Ulrik, Valentyna Yasinska, Davorka Sekulić, Kirk Geale, Celeste Porsbjerg, Lauri Lehtimäki, Vibeke Backer, Alexandra Cooper, Bernt Bøgvald Aarli, Jacqueline Wallen, Sylvia Packham
article en

Abstract

<bold>Background:</bold> Longitudinal data examining the impact of asthma severity on mortality are lacking. In this study, we aimed to explore all-cause and cause-specific mortality according to asthma severity. <bold>Methods:</bold> This prospective observational cohort study is based on Danish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research platform. Adult patients with severe asthma were matched on age and sex to 10 patients with mild-to-moderate asthma and followed from 2000-2020. Patients with COPD diagnosed prior to inclusion were excluded. Absolute and relative measures of risks of all-cause and cause-specific mortality were compared between severe and mild-to-moderate asthma. <bold>Results:</bold> We included 11,811 and 118,810 patients with severe and mild-to-moderate asthma, respectively. All-cause mortality was significantly higher in patients with severe asthma compared to patients with mild-to-moderate asthma, both in absolute measures of the cumulative mortality [34% (CI 95%: 32, 35) vs 20% (19, 20), p<0.001] after 20 years of follow-up and in relative measures [hazard ratio (HR)=1.99 (1.90, 2.09), p<0.001]. The HR of all-cause mortality was attenuated after adjustment for T2 inflammatory markers [HR 1.34 (95CI%: 1.09, 1.64)]. The leading causes of death in both groups were respiratory diseases, neoplasms, and cardiovascular diseases. When excluding patients who developed COPD during follow-up, the increased mortality risk in severe asthma patients remained significant. <bold>Conclusion:</bold> This prospective study revealed a significant excess mortality in patients with severe asthma compared to patients with mild to moderate asthma. This was primarily driven by respiratory-related deaths, and with T2 inflammation as a potential contributing mortality risk factor.

Epidemiology
Uppsala University (SE), Karolinska University Hospital (SE), University of Helsinki (FI), Uppsala University Hospital (SE), Tampere University of Applied Sciences (FI), Helsinki University Hospital (FI), Haukeland University Hospital (NO), Bispebjerg Hospital (DK), Hvidovre Hospital (DK), Tartu University Hospital (EE), Rigshospitalet (DK), Karolinska Institutet (SE), Sanofi (Netherlands) (NL), Tampere University Hospital (FI), Tampere University (FI), Zenterio (Sweden) (SE), Quantify Research (Sweden) (SE), GlaxoSmithKline (Sweden) (SE), Umeå University (SE)
Openalex Percentile: Top 55%
Asthma and respiratory diseases
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