Despite advances in treatment and the development of several asthma guidelines, asthma mortality rates remain high across Europe, with an estimated 17,000 asthma deaths reported in 2019.^1,2 It is considered that the majority of asthma deaths are largely preventable.³ A high number of asthma deaths can be attributed to inadequate education of patients on recognising risk and the appropriate action to take when asthma control is poor.

Asthma mortality trends in Europe

In 2019, there were approximately 43.5 million cases of asthma in Europe.¹ As the prevalence of asthma continues to rise and the condition has become increasingly common, the severity and risk of death are often underestimated, leading to a misconception that those who need few drugs to treat their condition are at a lower risk of asthma death.⁴ However, mortality rates remain high in certain parts of Europe.^1,4

Based on data from the World Health Organization (WHO) European region in 2019, the mortality of asthma is highest in Western Europe (40.6%), followed by Central Europe (10.4%) and then Eastern Europe (13.7%).¹ The distribution trends of mortality follow a similar pattern to asthma incidence trends across the WHO European region (40.6% in Western Europe, 10.4% in Central Europe and 13.7% in Eastern Europe).¹

Prevalence and mortality of asthma across Europe

Data taken from the International Respiratory Coalition: Lung Facts 2023 (Asthma). Available at: https://international-respiratory-coalition.org/diseases/asthma/ (Accessed April 2023)

Looking specifically at countries within the European region, the United Kingdom (UK) has one of the highest mortality rate for asthma (1524 deaths in 2019); Germany (1243 deaths), Spain (1122 deaths) and France (1138 deaths) are also among the countries with higher rates of asthma mortality.¹ However, notably lower asthma mortality has been reported in other European countries, including Italy (537 deaths), the Netherlands (116 deaths), Finland (110 deaths) and Croatia (55 deaths).¹

For more information on asthma prevalence and mortality across Europe, see our Asthma by Numbers Quick Fact Sheet

Risk factors for asthma death

Up to 30% of asthma deaths occur in people with mild cases, where symptoms are infrequent (e.g. occur less than weekly or only in strenuous exercise).⁴ The National Review of Asthma Deaths in the UK identified that the majority of patients who died from asthma were receiving treatment for mild or moderate asthma.⁵ Of note, nearly half died without seeking medical assistance or before emergency medical care could be provided, and the majority were not under specialist medical supervision during the year prior to death.⁵ As most asthma cases are mild, with severe cases occurring in <10% of patients, it is important to recognise the risk of asthma death across the entire patient population.^4,6

Patient-specific risk factors for asthma death have been identified and include:^2,7

• Poor adherence to medications and/or a written asthma action plan
• Hospitalisation or emergency care for asthma in the past year
• Use of oral corticosteroids
• Not using inhaled corticosteroids

Another key consideration when evaluating patient-specific risk factors is the association between socioeconomic status and mortality. This association has been highlighted in several investigations in Europe, whereby lower socioeconomic status is associated with worse disease control, increased exacerbation rates and higher rates of death.^8–11

Future considerations

Reports such as the Global Initiative for Asthma (GINA) guidelines and the National Review of Asthma Deaths (NRAD) detail suggested strategies to reduce the rates of asthma death.^4,5 In general, proactive as well as reactive patient review by a healthcare professional with training in asthma is advised, in order to identify those at risk of disease worsening and death.^4,5 This strategy may be very effective for patients who have access to and are engaged with local health services, however, may not account for regionally-specific and individual socioeconomic barriers to quality healthcare that many people with asthma face. Some examples include language barriers, a real or imagined fear of discrimination, inability to finance travel or medication and poor health education.¹²

With this in mind, it is imperativethat any systematic initiative aimed at decreasing asthma mortality focusses on identifying and accessing all people with asthma, and not only those who are currently able to seek and receive treatment. This notion is encapsulated by the theme chosen by GINA for the 2023 World Asthma Day, “Asthma care for All”, a message that aims to highlight existing disparities in asthma care and promote health equity among the vast and varied population of people living with asthma.

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