Researchers have found that almost every patient who died from an out-of-hospital acute asthma attack in Milwaukee during a 4-year period (2004-2008) was not using inhaled corticosteroids. The study reviewed medical records of 22 autopsies from the Milwaukee County Medical Examiner whose death certificates listed asthma as the primary cause of death. The findings were presented at last week’s Annual Meeting of the American Academy of Allergy, Asthma and Immunology.

In 20 of 22 cases, patients were relying on short-acting ß-agonist such as albuterol. Ten of the patients had been using other asthma medications, including six on oral steroids, three on montelukast, and one on omalizumab.

Stanley Szefler, MD, of National Jewish Health and the University of Colorado in Denver, who was not involved with the study, said the lack of inhaled corticosteroids in these cases was “not surprising, but concerning.” One problem, he said, may be that many asthma patients in cities receive much of their healthcare in emergency departments that deal mainly with the immediate symptoms that brought them in. Once patients feel better, they skip follow-up care, or cannot get appointments soon enough to maintain symptom control. “In the past, [emergency departments] would say ‘let’s take care of the acute illness’ and leave the chronic management to their regular physicians.”

The researchers also found that 64% of the patients were African-Americans, a disproportionately high percentage based on the Milwaukee-area population. The data showed that 77% of the patients died during the night or shortly upon awakening. In six cases, patients had histories of illicit drug use. When tobacco and alcohol were included, 13 of the cases had some history of drug use.