Asthma in older adults

Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges

As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.

Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey

BACKGROUND

The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown.

OBJECTIVE

To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found.

METHODS

Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression.

RESULTS

A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008).

CONCLUSIONS

Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.

Exposure to Indoor Mouldy Odour Increases the Risk of Asthma in Older Adults Living in Social Housing

Background: Indoor dampness is thought to affect around 16% of European homes. It is generally accepted that increased exposure to indoor dampness and mould contamination (e.g., spores and hyphae) increases the risk of developing and/or exacerbating asthma. Around 30% of people in the Western world have an allergic disease (e.g., allergy, wheeze and asthma). The role of indoor mould contamination in the risk of allergic diseases in older adults is yet to be fully explored. This is of interest because older people spend more time indoors, as well as facing health issues due to the ageing process, and may be at greater risk of developing and/or exacerbating asthma as a result of indoor dampness. Methods: Face-to-face questionnaires were carried out with 302 participants residing in social housing properties located in South West England. Self-reported demographic, mould contamination (i.e., presence of mould growth and mouldy odour) and health information was linked with the asset management records (e.g., building type, age and levels of maintenance). Multivariate logistic regression was used to calculate the odd ratios and confidence intervals of developing and/or exacerbating asthma, wheeze and allergy with exposure to reported indoor mould contamination. We adjusted for a range of factors that may affect asthma outcomes, which include age, sex, current smoking, presence of pets, education, and building type and age. To assess the role of mould contamination in older adults, we compared younger adults to those aged over 50 years. Results: Doctor-diagnosed adult asthma was reported by 26% of respondents, 34% had current wheeze while 18% had allergies. Asthma was common among subjects exposed to reported visible mould (32%) and reported mouldy odour (42%). Exposure to visible mould growth and mouldy odour were risk factors for asthma, but not for wheeze or allergy. Exposure to mouldy odour increased the risk of asthma in adults over the age of 50 years (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.10–5.34) and the risk was higher for females than for males (OR 3.5, 95% CI 1.37–9.08). These associations were modified by a range of built environment characteristics. Conclusions: We found that older adults living in social (public) housing properties, specifically women, may be at higher risk of asthma when exposed to mouldy odour, which has a number of implications for policy makers and practitioners working in the health and housing sector. Additional measures should be put in place to protect older people living in social housing against indoor damp and mould contamination.

An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly

Asthma in the elderly (>65 yr old) is common and associated with higher morbidity and mortality than asthma in younger patients. The poor outcomes in this group are due, in part, to underdiagnosis and undertreatment. There are a variety of factors related to aging itself that affect the presentation of asthma in the elderly and influence diagnosis and management. Structural changes in the aging lung superimposed on structural changes due to asthma itself can worsen the disease and physiologic function. Changes in the aging immune system influence the cellular composition and function in asthmatic airways. These processes and differences from younger individuals with asthma are not well understood. Phenotypes of asthma in the elderly have not been clearly delineated, but it is likely that age of onset and overlap with chronic obstructive pulmonary disease impact disease characteristics. Physiologic tests and biomarkers used to diagnose and follow asthma in the elderly are generally similar to testing in younger individuals; however, whether they should be modified in aging has not been established. Confounding influences, such as comorbidities (increasing the risk of polypharmacy), impaired cognition and motor skills, psychosocial effects of aging, and age-related adverse effects of medications, impact both diagnosis and treatment of asthma in the elderly. Future efforts to understand asthma in the elderly must include geriatric-specific methodology to diagnose, characterize, monitor, and treat their disease.

Comparative Clinical, Physiological, and Inflammatory Characteristics of Elderly Subjects With or Without Asthma and Young Subjects With Asthma

BACKGROUND

Asthma seems to present in the elderly as a specific phenotype that remains to be further described. In this prospective observational study, we aimed to assess the multidimensional aspects of asthma in the elderly.

METHODS

In young (18 to 35 years old) subjects with mild to moderate asthma and elderly subjects (aged ≥60 years) either with or without mild to moderate asthma, we compared asthma control, health care and medication use, lung function, markers of airway and systemic inflammation, and adherence to therapy.

RESULTS

Fifty subjects were recruited in each group. Elderly people with asthma showed more marked airway obstruction compared with young people with asthma and elderly people without asthma. They also had poorer asthma control, mainly associated with a lower FEV₁, compared with young people with asthma, although airway responsiveness, health care use, prescribed doses of inhaled corticosteroids, and adherence to treatment were similar in both groups. Elderly subjects had an increase in some markers of systemic inflammation and bronchial epithelial dysfunction compared with young people with asthma. Blood eosinophils were higher in both asthma groups, particularly in elderly people with asthma. Sputum neutrophils were increased in both groups of elderly subjects and sputum eosinophils were increased in elderly people with asthma compared with the other two groups.

CONCLUSIONS

Asthma in the elderly presents as a specific phenotype associated with increased airway obstruction and mixed airway inflammation in addition to signs of systemic inflammation.

Predictors of asthma control in elderly patients

PURPOSE OF REVIEW

We are in the era of rapid aging of the global population. Elderly asthmatic patients have an increased frequency of hospitalization and a high mortality rate. In this review, we focus on comorbidities and treatment issues in terms of the predictors of asthma control in the elderly.

RECENT FINDINGS

Some frequent comorbidities, such as chronic obstructive pulmonary disease, chronic sinusitis, obesity, and depression, are associated with uncontrolled asthma in elderly asthmatic patients. Smoking status in elderly asthmatic patients was associated with more frequent exacerbations. Management of comorbidities should be taken into account when we treat elderly asthmatic patients. Low treatment adherence, which is common in elderly asthmatic patients, predicts poor asthma control status. A poor knowledge about asthma, cognitive function impairment, and inappropriate inhaler technique result in low treatment adherence. Polypharmacy is associated with low treatment adherence, adverse drug reactions, and drug-drug interactions, and it is supposed to be a predictor of asthma control.

SUMMARY

Multifactorial assessments, including comorbidities, treatment adherence, and polypharmacy, are important for better asthma control in elderly asthmatic patients. Further studies on the strategy for the management of elderly asthmatic patients in a real-world setting are warranted.

Asthma in the Elderly

The older population has seen the greatest increase in the prevalence of current asthma in recent years. Asthma may begin at any age and when it occurs at an advanced as opposed to a young age, it is often nonatopic, severe, and unremitting. Unfortunately, geriatric-specific guidelines are not available for the diagnosis and treatment of asthma. However, with objective monitoring, avoidance of asthma triggers, appropriate pharmacotherapy, and patient education, the disease can be managed successfully.

Characteristics of Complementary and Alternative Medicine (CAM) use among older adults with asthma

OBJECTIVE

A growing number of asthma patients are using Complementary and Alternative Medicine (CAM). Prior studies have not examined CAM use among the older adult population.

METHODS

Data from the 2011 Behavioral Risk Factor Surveillance Survey (BRFSS), a national telephone survey, and the Asthma Call-Back survey (ACBS), a survey conducted among BRFSS individuals reporting asthma, were used for the analyses. The study population consisted of 7685 individuals aged 55 years or older with current asthma. The relationship of CAM use with demographic and asthma outcomes was analyzed using logistic regression.

RESULTS

CAM use was reported by 39% (3030). Breathing techniques were the most commonly reported CAM therapy. Demographic factors associated with CAM use include female gender (OR 1.36, p < 0.002), having at least a college education (OR 1.76, p < 0.001), cost barrier to healthcare (OR 1.43, p < 0.001), and living in the West (OR 1.31, p < 0.01). An inverse relationship was noted between income and CAM use. Those who had received an asthma action plan (OR 1.29, p < 0.005), current smokers (OR 1.35, p < 0.02), or impaired asthma control (as defined by symptoms affecting sleep, symptoms limiting activities, and rescue medication use) were more likely to use CAM (OR 1.37, p < 0.001; OR 1.38, p < 0.001; and OR 1.2, p < 0.046, respectively).

CONCLUSIONS

A large proportion of asthmatic older adults use CAM. In addition, older adults with asthma who use CAM have decreased asthma control, and further studies are needed to determine a causal role.

Assessing the association of obesity and asthma morbidity in older adults

BACKGROUND

Obesity is a robust predictor of poor asthma control in younger adults. Given the high prevalence of asthma and obesity in older Americans, weight reduction could benefit asthma management in this population.

OBJECTIVE

To assess the association between obesity and asthma outcomes among older adults.

METHODS

We recruited from urban primary care clinics a prospective cohort of nonsmoking individuals with asthma who were 60 years or older without a history of other respiratory diseases. At baseline, body mass index (BMI) measurements were classified as normal (BMI, 18-25), overweight (BMI, 25-30), or obese (BMI, >30). Measures of asthma morbidity (Asthma Control Questionnaire [ACQ], and Mini Asthma Quality of Life Questionnaire [Mini-AQLQ]) and asthma-related resource utilization (inpatient or outpatient) were taken at baseline and at 3- and 12-month interviews. We used generalized estimating equation models to assess associations between obesity and asthma outcomes after controlling for potential confounders.

RESULTS

Of the 437 older adults with asthma in the study, 17% had a normal BMI, 32% were overweight, and 51% were obese. Unadjusted analyses revealed that obesity was associated with lower ACQ scores (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09-1.31) and poorer Mini-AQLQ scores (OR, 1.21; 95% CI, 1.11-1.33). Adjusted analyses revealed no significant association between obesity and ACQ (OR, 1.05; 95% CI, 0.96-1.15) and Mini-AQLQ (OR, 1.08; 95% CI, 0.99-1.19).

CONCLUSION

Our study suggests that obesity is not independently associated with worse asthma outcomes in older adults, reflecting potential differences in the mechanisms that link obesity with asthma control in older vs younger populations.

Asthma in the elderly patient

Asthma affects a significant proportion of elderly patients, but unfortunately, it is responsible for a high asthma-related morbidity and mortality in this population. This may be related not only to the development of a more severe asthma phenotype compared to younger patients, with more marked airway obstruction and a more neutrophilic type of airway inflammation, but also to the presence of many co-morbid conditions. Furthermore, in older patients, asthma is often under-diagnosed, undertreated and poorly managed. Unfortunately, elderly patients have usually been excluded of clinical trials on asthma and there is an urgent need to perform more research on the optimal management of asthma in this population.

Enhanced allergic airway disease in old mice is associated with a Th17 response

BACKGROUND

The prevalence of asthma in the elderly is increasing and associated with higher mortality than in children or young adults. However, the effects of age on the development and character of allergic asthma have been understudied. It has been suggested that mixed Th2/Th17 responses cause more severe forms of asthma, but the role of Th17 response in allergic airway disease and aging is not well understood.

OBJECTIVE

To investigate age-dependent characteristics and Th17 immune response in allergic airway disease in a murine house dust mite (HDM)-allergen model.

METHODS

Twelve-week-old and 15-month-old male BALB/c mice were sensitized and challenged with HDM. Bronchoalveolar lavage fluid (BALF), airway inflammation and hyperresponsiveness (AHR), serum immunoglobulin and splenic T cells were assessed. Age-related T cell activation was analyzed in a co-culture with bone marrow-derived dendritic cells (BMDC) and splenic CD4(+) T cells from young and old mice.

RESULTS

Features of allergic airway disease such as mucous cell hyperplasia, infiltration of airway eosinophils and lymphocytes, Th2 cytokine expression and serum IgG1 levels were greater in old compared to young mice. In contrast to the more marked inflammatory/immune responses to HDM in old mice, AHR was greater in young HDM-treated mice. Only the old mice developed airway neutrophil infiltration and a Th17 immune response upon HDM exposure, with increases in BALF cytokines IL-17A and KC, and Th17 cytokine producing T cells in the spleen. Stimulation of CD4(+) T cells and BMDC co-cultures with HDM, resulted in an enhanced Th17 cytokine response in cells isolated from old mice.

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings in mice suggest that the severity and character of allergic airway disease are age dependent, with a bias towards a Th17 immune response with aging. Elderly, asthmatics may be prone to develop severe allergic airway inflammation with a mixed Th2/Th17 immune response.

Asthma in the elderly: what we know and what we have yet to know

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.

[Asthma in the elderly]

Asthma is a common condition in the elderly although often confounded with chronic obstructive pulmonary disease (COPD) in this population. Asthma in the elderly seems to represent a specific phenotype characterized by more severe, but often less perceived, airway obstruction, a neutrophilic or mixed-type of airway inflammation and frequent comorbidities. Patients aged 65 years and over have an increased asthma-related morbidity and mortality compared to younger patients, probably due to difficulties in regard to diagnosis, assessment of the disease severity and treatment. Research is urgently needed to determine the optimal treatment of the aged patient. In this document we will review the state of knowledge on this topic and discuss the challenges of multidisciplinary asthma management in the elderly.

The asthma knowledge and perceptions of older Australian adults: implications for social marketing campaigns

OBJECTIVE

The purpose of this research is to gain an understanding of the asthma perceptions of older adults and identify gaps in their asthma knowledge.

METHODS

In regional New South Wales, Australia, a stratified, random sample of 4066 adults, aged 55 years and over, both with and without an asthma diagnosis, completed a survey based on the Health Belief Model about asthma knowledge and perceptions.

RESULTS

Almost half of the sample had experienced symptoms of breathlessness in the past four weeks. Breathlessness was a predictor of lower health ratings and poorer mood. Older adults reported low susceptibility to developing asthma. The sample demonstrated poor knowledge of key asthma symptoms including shortness of breath, tightness in the chest and a cough at night.

CONCLUSION

There is a general lack of asthma awareness in this age group. This could result in not seeking medical help, and thus a reduced quality of life.

PRACTICAL IMPLICATIONS

Older adults should be made aware of key symptoms and the prevalence of asthma in the older adult population, and be empowered to take control of their respiratory health. Audience segmentation for an intervention should be based on recent experience of breathlessness and asthma diagnosis.

Asthma in the elderly: Current understanding and future research needs--a report of a National Institute on Aging (NIA) workshop

Asthma in the elderly is underdiagnosed and undertreated, and there is a paucity of knowledge on the subject. The National Institute on Aging convened this workshop to identify what is known and what gaps in knowledge remain and suggest research directions needed to improve the understanding and care of asthma in the elderly. Asthma presenting at an advanced age often has similar clinical and physiologic consequences as seen with younger patients, but comorbid illnesses and the psychosocial effects of aging might affect the diagnosis, clinical presentation, and care of asthma in this population. At least 2 phenotypes exist among elderly patients with asthma; those with longstanding asthma have more severe airflow limitation and less complete reversibility than those with late-onset asthma. Many challenges exist in the recognition and treatment of asthma in the elderly. Furthermore, the pathophysiologic mechanisms of asthma in the elderly are likely to be different from those seen in young asthmatic patients, and these differences might influence the clinical course and outcomes of asthma in this population.

Asthma and ageing: an end user's perspective--the perception and problems with the management of asthma in the elderly

Despite the high prevalence of asthma in the elderly, its development, diagnosis, and treatment are under-researched. This paper provides a comprehensive review of the current state of knowledge in relation to management of asthma in the elderly - focusing on barriers to diagnosis and treatment and the central role of self-management. Asthma prevalence increases with age, as does the risk of dying from asthma, and with the ageing of the population and increasing life expectancy, the prevalence of (diagnosed and undiagnosed) asthma in older adults is expected to increase drastically, placing an increasing burden on sufferers, the community and health budgets. Asthma sufferers are more likely to be psychologically distressed and at a higher risk of anxiety and depression, more likely to experience a sense of lack of control over their health and to have lower self-reported quality of life. Asthma is under-diagnosed, and under-treated, in the elderly, further exacerbating these negative consequences. The review concludes, among other things, that there is a need to better understand the development and impact of asthma in the elderly, to increase community awareness of asthma in the elderly, to improve both 'medical management' and 'self-management' in this population and to develop more effective tools for diagnosis and treatment of asthma in the elderly. The paper concludes with key recommendations for future research and practice in this area.

Asthma in the Elderly: Can We Distinguish It from COPD?

Asthma in older adults affects quality of life and results in a higher hospitalization rate and mortality. In common clinical practice, asthma in the elderly is underdiagnosed and undertreated or overdiagnosed and mistreated. The age-related reduction in perception of shortness of breath and the high incidence of comorbidities make the diagnosis and management more difficult and challenging for the physicians. Chronic obstructive pulmonary disease (COPD) is usually easy to distinguish from asthma, but sometimes the distinction from late-onset asthma in older patients, particularly in cigarette smokers, is difficult and may be impossible. Both diseases are characterized by the presence of airflow obstruction but have distinct pathogenesis, inflammatory pattern, and prognosis. The distinction between Asthma and COPD based simply on spirometric parameters is difficult especially in the elderly asthmatics. The combination of lung function testing, bronchial hyperresponsiveness (BHR) and atopy status, HRCT scans, and the newly developed biological techniques, allowing the assessment of biomarker profiles, could facilitate the distinction between these diseases.

Effect of age on asthma control: results from the National Asthma Survey

BACKGROUND

two million US citizens older than 65 years have asthma, but little is known about asthma control in this population.

OBJECTIVE

to compared short- and long-term asthma control in elderly (≥ 65 years old) and young adult (18-64 years old) populations from the National Asthma Survey.

METHODS

data from the National Asthma Survey (sponsored by the Centers for Disease Control and Prevention) were analyzed. Demographic variables, health insurance status, smoking status, indoor allergen exposure, and asthma education were compared between the young adult and elderly populations. Asthma control was examined based on short-term measures (recent oral corticosteroid bursts or symptoms) and long-term measures (asthma attacks, urgent care visits, hospitalizations, and activity limitation in the previous year).

RESULTS

a total of 2,557 young and 398 elderly asthmatic patients were included. Elderly patients had a lower income, were less educated, were more obese, were more insured, had less indoor exposure, and were more likely to be former smokers. They were less educated about asthma attack interventions and asthma action plans (P < .05 for both). On multivariate analysis, elderly patients had worse control of asthma based on short-term measures (daytime symptoms in the previous month [odds ratio (OR), 1.73; 95% confidence interval (CI), 1.25-2.35] and any short-term measure [OR, 1.48; 95% CI, 1.11-1.97]) and long-term measures (activity limitation in the previous year [OR, 1.50; 95% CI, 1.12-2.01]).

CONCLUSIONS

elderly asthmatic patients have worse short- and long-term asthma control compared with the young adult population. Further studies are needed to elucidate whether these findings are due to pathophysiologic differences and whether tailored education or other novel strategies can provide better asthma control.

Respiratory exercise program for elderly individuals with asthma

INTRODUCTION

Asthma in older adults is frequently underdiagnosed, as reflected by approximately 60% of asthma deaths occurring in people older than age 65.

OBJECTIVE

The present study evaluates the effects of a respiratory exercise program tailored for elderly individuals with asthma. We are not aware of any other reports examining breathing exercises in this population.

METHODS

Fourteen patients concluded the 16-week respiratory exercise program. All the patients were evaluated with regard to lung function, respiratory muscle strength, aerobic capacity, quality of life and clinical presentation.

RESULTS

After 16 weeks of this open-trial intervention, significant increases in maximum inspiratory pressure and maximum expiratory pressure (27.6% and 20.54%, respectively) were demonstrated. Considerable improvement in quality of life was also observed. The clinical evaluations and daily recorded-symptoms diary also indicated significant improvements and fewer respiratory symptoms. A month after the exercises were discontinued, however, detraining was observed.

DISCUSSION

In conclusion, a respiratory exercise program increased muscle strength and was associated with a positive effect on patient health and quality of life. Therefore, a respiratory training program could be included in the therapeutic approach in older adults with asthma.

Asthma education for older adults: results from the National Asthma Survey

RATIONALE

Although asthma education is effective in younger population, it is unknown whether it is effective in older adults.

METHODS

Using the Four-State National Asthma Survey (NAS) data, asthma control was compared between older adults (≥65 years) who had been taught to use a peak flow meter (PFM) and asthma action plan (AAP) with those who had not. We also compared older adults who had taken an asthma course with those who had not. Both short-term (symptoms within last 1 week, day and night symptoms in last 30 days, and the use of steroid in last 3 months) and long-term (asthma attack, emergency department visit, hospitalizations, and activity limitations in the prior year) outcomes were compared.

RESULTS

Three hundred and ninety-eight older adults with asthma were identified. There were no differences in the short- and long-term asthma outcomes between the older adults who had or had not received instruction on PFM or AAP use. In preliminary analysis, those who took AC were more likely to have at least one poorly controlled long-term outcome measure (81 vs. 65%, p = 0.034). However, this difference did not remain significant in a logistic regression analysis.

CONCLUSIONS

Engagement in asthma education course, instruction on action plans, and instruction on PFM use does not appear to affect asthma outcomes in older adults. Education specifically tailored toward older adults is required for better asthma control.

Airway obstructive diseases in older adults: from detection to treatment

Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adults. Smoking, air pollution, and bronchial hyperresponsiveness are the main risk factors. The treatment of these diseases in older adults does not differ from the available guidelines but may be complicated by the presence of comorbidities. Smoking cessation is essential for smokers, and pulmonary rehabilitation must be considered regardless of the age of the patient.

Health across generations: findings from the Australian Longitudinal Study on Women's Health

Interpretation of changes in health and health care utilization patterns across the life span depends on an understanding of the effects of age, period, and cohort. The purpose of this article is to illustrate differences among three generations of women in demographic factors, health risk factors, and health status indicators from 1996 to 2008. The article examines data from the Australian Longitudinal Study on Women's Health, a broad-ranging project funded by the Australian Government Department of Health and Ageing (DoHA) and involving three age groups of women (born in the periods 1973-1978, 1946-1951, and 1921-1926) who were first surveyed in 1996 and will be surveyed every 3 years until at least 2015. Patterns in selected demographic factors (marital status and level of educational qualification), health risk factors (smoking, alcohol consumption, physical activity, and body mass index [BMI]), and health status indicators (asthma, hypertension, diabetes and depression; physical functioning and mental health scores from the SF-36) were examined to illustrate examples of biological age, generational differences, or period effects that affect all age groups and generations simultaneously. The results can be used to inform the development of responsive and effective models for both prevention and management of chronic disease, including health and aged-care systems that will meet the needs of different generations of women across their life span.

Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study

Background

Relatively few studies have examined survival by pharmacotherapy level and the effects of patient characteristics on mortality by pharmacotherapy level in older chronic respiratory disease (CRD) patients. This study aimed to investigate these issues in older (≥ 65) CRD patients in Western Australia.

Methods

We identified 108,312 patients ≥ 65 years with CRD during 1992-2006 using linked medical, pharmaceutical, hospital and mortality databases held by the Commonwealth and State governments. Pharmacotherapy classification levels were designed by a clinical consensus panel. Cox regression was used to investigate the study aim.

Results

Patients using only short acting bronchodilators experienced similar, but slightly worse survival than patients in the highest pharmacotherapy level group using high dose inhaled corticosteroids (ICS) ± long acting bronchodilators (LABs) ± oral steroids. Patients using low to medium dose ICS ± LABs experienced relatively better survival. Also, male gender was associated with all-cause mortality in all patients (HR = 1.72, 95% CI 1.65-1.80) and especially in those in the highest pharmacotherapy level group (HR = 1.97, 95%CI = 1.84-2.10). The P-value of interaction between gender and pharmacotherapy level for the effect on all-cause death was significant (0.0003).

Conclusions

Older patients with CRD not using ICS experienced the worst survival in this study and may benefit from an escalation in therapeutic regime. Males had a higher risk of death than females, which was more pronounced in the highest pharmacotherapy level group. Hence, primary health care should more actively direct disease management to mild-to-moderate disease patients.

Asthma in the elderly

Asthma is frequent among older people. Nevertheless, under-recognition, misdiagnosis and under-treatment are still relevant issues. We aim to provide an overview of epidemiology of asthma in the elderly, and a thorough description of its pathology and clinical presentation, with special emphasis on the distinction of late versus early-onset asthma. We also discuss selected treatment topics of special interest for older patients, such as compliance with therapy and ability with the inhalers, which are basic to the success of the prescribed therapy. Finally, we suggest that multidimensional geriatric assessment of older asthmatics could help in tailoring the therapy to the individual needs and capacity.

Asthma in the elderly: current knowledge and future directions

PURPOSE OF REVIEW

Asthma is a common disease in the older population that is frequently undiagnosed and undertreated. We will review the current knowledge of asthma in the elderly (AIE) and shed light on the diagnostic and management challenges outlining needs for future research.

RECENT FINDINGS

There has been very little original research in the field of AIE published in the last few years, and current literature focuses primarily on a series of review articles. AIE often presents with multiple comorbidities, which complicates its course and management. There is renewed interest in nonallergic (intrinsic) asthma. T helper cell 1 inflammation triggered by respiratory infection, superantigens, proteases and interleukin 17 are possible mechanisms. An association between systemic inflammation in frailty and asthma may also be important.

SUMMARY

The diagnosis and treatment of AIE requires that the individual patient and his or her specific triggers and the likely pathophysiology be understood. Understanding the mechanisms of inflammation in this population is key to improved therapeutic interventions.

Complexities of diagnosis and treatment of allergic respiratory disease in the elderly

Atopic diseases such as rhinitis and asthma are relatively common in children and young adults. However, many patients aged >65 years are also affected by these disorders. Indeed, the literature suggests that between 3-12% and 4-13% of individuals in this age range have allergic rhinitis and asthma, respectively. However, these numbers are most likely underestimates because atopic diseases are frequently not considered in older patients. The diagnosis of both allergic rhinitis and asthma in older patients is more difficult than in younger patients because of a wide differential diagnosis of other diseases that can produce similar symptoms and must be excluded. Furthermore, treatment of these disorders is complicated by the potential for drug interactions, concern about the adverse effects of medications, in particular corticosteroids, and the lack of drug trials specifically targeting treatment of older patients with allergic rhinitis and asthma.

[Asthma among senior adults]

Elderly patients with asthma are a specific group with particular needs. These must be addressed in order to provide appropriate asthma care. Asthma causes higher morbidity and mortality rates among the elderly patients. Older patients often fail or have problems with compliance and self-management due to age-specific factors. Older patients with asthma are often misdiagnosed, due to an impaired patient perception of symptom severity, different opinions of what kind of asthma-control is possible, or not sufficient communication skills. Often the quality of life is impaired by asthma. Improvement in self management skills in a special way may enhance the health status of elderly patients with asthma.