A large-scale Nordic study has found that patients living with severe asthma face significantly higher mortality risks than those with milder forms of the disease, underscoring the urgent need for improved management and targeted treatment strategies. The paper, “Mortality in Severe Asthma: Results From the NORDSTAR Cohort,” was published in the European Respiratory Journal.
Researchers used data from the Nordic Dataset for Asthma Research (NORSTAR) cohort to study more than 130,000 adult patients over a 20‑year period — one of the most comprehensive reviews of long‑term mortality patterns in asthma patients. NORDSTAR comprises patients with asthma from Denmark, Sweden, Norway and Finland. Investigators compared outcomes between individuals with severe asthma and those with mild‑to‑moderate disease.
The findings reveal a stark contrast between the two groups. Over two decades of follow‑up, 34% of patients with severe asthma died, compared with 20% of those with mild‑to‑moderate asthma. Even after accounting for demographic factors, patients with severe asthma were found to have nearly twice the risk of death overall, with a hazard ratio of 1.99.
Although deaths directly attributed to asthma were relatively rare, the study found that individuals with severe asthma had nearly three times the risk of asthma‑specific death compared to their counterparts.
“We see that comorbidities and recurrent exacerbations are likely driving the risks, rather than the asthma attacks themselves,” said Apostolos Bossios, MD, PhD, in a news release. Dr. Bossios is an investigator in the study and an associate professor of respiratory medicine at the Karolinska Institute in Stockholm, Sweden.
Researchers noted that other conditions also contributed to the elevated risk, including:
- Cancer: 7.5% (severe) versus 5.9% (mild‑to‑moderate)
- Cardiovascular disease: 4.7% versus 3.8%, respectively
When adjusting for oral corticosteroid (OCS) use, researchers found the mortality risk dropped significantly, suggesting that long‑term steroid exposure may be linked to poorer outcomes. Additionally, markers of type 2 (T2) inflammation, which is commonly associated with allergic and eosinophilic asthma, were found to influence mortality risk, highlighting the importance of personalized treatment approaches, researchers noted.
According to investigators, the findings reinforce the need for:
- Improved early identification and management of severe asthma
- Greater use of targeted therapies, including biologics
- Careful monitoring of long‑term corticosteroid exposure
The study’s authors said the results demonstrate that severe asthma should be treated not only as a chronic respiratory condition but also as a systemic disease with broader health implications. With severe asthma affecting a smaller but high‑risk segment of the asthma population, researchers emphasized the importance of focusing clinical and healthcare resources on this group.
