Severe asthma: an indirect, subtle killer

Extract One of the most infamous murderers in history, Charles Manson, never directly killed anyone. Something similar can happen with asthma, which, while not the direct cause of death, can facilitate it through indirect mechanisms. The study reported by Hansen et al. [1] in this issue of the European Respiratory Journal investigated all-cause and cause-specific mortality in patients with severe asthma compared to those with mild-to-moderate asthma using comprehensive Danish registry data. They focused on the critical, interlinked themes of asthma control, oral corticosteroid (OCS) use, comorbidities and death, and concluded a near-doubling of all-cause mortality in severe asthma and a three-fold increased risk of asthma-related death. The shift in primary causes of death (respiratory diseases dominating in severe asthma versus cancer in mild-to-moderate asthma) is a highly significant clinical finding.