Decrease in asthma mortality rate in Israel from 1991-1995: Is it related to increased use of inhaled corticosteroids?

Background: Asthma mortality rates (AMRs) during the last several decades increased in many countries with developed medical services, including Israel. The reasons for this trend were never established. Recent data suggested that this trend is changing. Objectives: We sought to compare the AMR in Israel during 1991-1995 with that of the previous decade and to investigate a possible correlation between mortality rates and use of inhaled corticosteroids (ICSs) and beta(2)-agonists. Methods: Statistical data on the AMR in Israel during 1981-1995 were extracted. Data were analyzed for 5- and 10-year periods (1981-1990) and compared with a 5-year period (1991-1995). Data on ICS and beta(2)-agonist sales were extracted from the marketing companies' official reports. Results: The mean AMR per 100,000 population per year during 1981-1990 in the 5- to 34-year-old group was 0.393 +/- 0.055 and decreased to 0.202 +/- 0.046 during the 1991-1995 period (P = .03). There was no significant difference between changes in mean AMR in the 35- to 64-year-old or in the 5- to 64-year-old group during the same periods (4.568 vs 4.063 and 2.480 vs 2.133). The mean ICS unit sales rates (per 100,000 population per year) between 1982-1990 and 1991-1995 were 21.70 and 190.45, respectively (P < .05). The correlation between ICS sales and AMR was -0.631 (P = .016). Sales of beta(2)-agonists did not change significantly during the study period. Conclusions: We identified a trend of decreased AMRs in Israel during 1991-1995. The decline in AMRs paralleled the increase in ICS sales, whereas the sales of inhaled beta(2)-agonists did not change significantly. One may speculate that the decrease in AMR may be the result of better anti-inflammatory treatment, as reflected by the increased use of ICSs, The feasibility of reducing AMRs in a country such as Israel, with low AMRs to start with, by improving medical treatment is encouraging.