Asthma mortality in Japan: What can be done to bring the rate down?

ABSTRACTThere is a major problem from asthma in Japan due to its high prevalence, morbidity, economic cost and mortality. The striking feature of the time trends in asthma mortality in Japan is the two epidemics of asthma mortality in young people that occurred at the same time as similar epidemics in a number of other countries. These epidemics are likely to be due, at least in part, to the overuse of specific β-adrenergic receptor agonist drugs, namely isoprenaline and fenoterol. Following recent warnings by the Japanese Ministry of Health and Welfare against the use of fenoterol and the resulting reduction in fenoterol sales, together with other changes in management consistent with the recommendations of the Japanese Asthma Guidelines, the asthma mortality rate has again fallen in Japan. However, Japan still has case fatality rates that are disproportionately greater than those in other countries. One approach that can be taken to reduce the high asthma mortality rate in Japan is to develop and implement a community based asthma self-management plan system of care whereby patients are provided with a practical system by which they can assess the severity of their asthma, a treatment regimen for both long-term therapy and management of a severe attack, and written guidelines provided by their medical practitioners in which assessment and treatment are integrated in a simple format. In controlled studies, this management approach has been shown not only to markedly reduce asthma mortality, in terms of reduction in hospital admissions and nocturnal wakening, but also to markedly reduce mortality from asthma. The Japanese Asthma Guidelines have advocated this approach, which is referred to as the 'asthma management zone system'. Through implementation of this system of care, together with other management initiatives, it is likely that the mortality rate from asthma will fall further over forthcoming years