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Use of anti-inflammatory therapy and asthma mortality in Japan

From the Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, and the Departments of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada

CORRESPONDENCE: S. Suissa, Division of Clinical Epidemiology Royal Victoria Hospital, 687 Pine avenue west, Ross 4.29, Montreal, Québec, Canada, H3A 1A1. Fax: 1 5148431493. E-mail: samy.suissa@clinepi.mcgill.ca

Keywords: asthma, epidemiological studies, inhaled glucocorticoids, leukotriene receptor antagonist, mortality, secular trends

Received: July 4, 2002
Accepted August 21, 2002

This study was funded by grants from the Canadian Institutes of Health Research (CIHR) and the Fonds de la recherche en santé du Québec. S. Suissa is the recipient of a Distinguished Senior Scientist award from the CIHR.

Asthma treatment guidelines were introduced in Japan in the 1990s, insisting as elsewhere, on the importance of anti-inflammatory therapy. The present study assessed whether use of anti-inflammatory medications was associated with a decrease in asthma mortality in Japan, the first country to use leukotriene receptor antagonists.

A population-based ecological study was conducted, spanning the period 1987–1999, among people aged 5–34 yrs in Japan. The association between the yearly rate of asthma death and sales of inhaled corticosteroids and leukotriene receptor antagonists was estimated using Poisson regression.

The yearly asthma death rate was stable at 6–7 deaths per million before the introduction of leukotriene receptor antagonists in 1995 and decreased by 23% thereafter, reaching 3.5 per million in 1999. The rate of asthma death was found to decrease with increasing use of both leukotriene receptor antagonists and inhaled corticosteroids. The rate ratio of asthma death was 0.96 per 1 million 25-day treatment courses of inhaled corticosteroids and 0.80 for every 1 million 25-day treatment courses of leukotriene receptor antagonists, consumed per year in Japan.

The increasing use of inhaled corticosteroids and leukotriene receptor antagonists may have contributed to the significant reduction in asthma mortality among young asthmatics in Japan.

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