Quality of life in elderly subjects with a diagnostic label of asthma from general practice registers

Interaction effect of chronic cough and ageing on increased risk of exacerbation in patients with asthma: a prospective cohort study in a real-world setting

Background

Older adults with asthma have the greatest burden and worst outcomes, and there is increasing evidence that chronic cough (CC) is associated with asthma severity and poor prognosis. However, the clinical characteristics of older adult patients with both asthma and CC remain largely unknown.

Methods

Participants with stable asthma underwent two cough assessments within 3 months to define the presence of CC. Patients were divided into four groups based on CC and age (cut-off ≥60 years). Multidimensional assessment was performed at baseline, followed by a 12-month follow-up to investigate asthma exacerbations. Logistic regression models were used to explore the interaction effect of CC and age on asthma control and exacerbations.

Results

In total, 310 adult patients were prospectively recruited and divided into four groups: older CC group (n=46), older non-CC group (n=20), younger CC group (n=112) and younger non-CC group (n=132). Compared with the younger non-CC group, the older CC group had worse asthma control and quality of life and increased airflow obstruction. The older CC group showed an increase in moderate-to-severe exacerbations during the 12-month follow-up. There was a significant interaction effect of CC and ageing on the increased moderate-to-severe exacerbations (adjusted risk ratio 2.36, 95% CI 1.47-3.30).

Conclusion

Older asthma patients with CC have worse clinical outcomes, including worse asthma control and quality of life, increased airway obstruction and more frequent moderate-to-severe exacerbations, which can be partly explained by the interaction between CC and ageing.

Relationship between health-related quality of life and respiratory health status among coal-based sponge iron plant workers in Barjora, India

BACKGROUND

Many coal-based sponge iron plant workers have poor health-related quality of life in general, and specifically a poor respiratory health status. However, the relationship between their health-related quality of life and respiratory health status is unknown.

AIM

This study investigated the relationship between health-related quality of life, measured using the EuroQol-5D (EQ5D), and respiratory health status, measured using the St. George's Respiratory Questionnaire (SGRQ), among coal-based sponge iron plant workers in Barjora, India.

METHOD

A cross-sectional study was conducted among coal-based sponge iron plant workers in Barjora, and complete data were available on 252 participants. Spearman's rank correlation coefficients were reported to show the strength of relationship between health-related quality of life and respiratory health status.

RESULTS AND CONCLUSION

Significant correlations were found between all EQ5D dimensions/visual analogue scale (VAS) and all SGRQ scores except between EQ5D-VAS and SGRQ-activity. A range of correlations was found. They were moderate between EQ5D-anxiety/depression and SGRQ-symptom, EQ5D-VAS and SGRQ-symptom, and EQ5D-anxiety/depression and SGRQ-total, but weak between all the other factors.

Relationships Between Quality of Life in the Psychological Domain, Acceptance of Illness, and Healthcare Services in Patients with Asthma

Asthma patients should be considered not only in terms of the medical aspects, but also the nonmedical issues associated with the psychological domain, since these are factors that can significantly improve patients' health state, quality of life, and illness acceptance, and can contribute to the reduction of healthcare utilization. The purpose of this study was to assess the acceptance of illness among asthma patients and their quality of life in the psychological domain, as well as to identify factors that influence illness acceptance and quality of life in the psychological domain. We examined 172 patients with asthma (median age: 58; range: 18-89 years) recruited from two pulmonology wards. We demonstrate that the patients with low levels of illness acceptance and a high healthcare service index had low quality of life in the mental domain. Older age; being separated, divorced, or widowed; and having BMI > 25, all significantly affect the levels of quality of life and illness acceptance. In conclusion, measurements of health-related quality of life and illness acceptance are useful for estimating the impact and progression of asthma. These results confirm that psychological functioning should be taken into account alongside the somatic state.

Psychological characteristics of patients with asthma

INTRODUCTION

Psychological distress of patients with asthma may be reduced when they learned to live with their illness. Asthma can change the psychological and personality characteristics. We aim to investigate the psychological and personality characteristics of patients with asthma using MMPI (Minnesota Multiphasic Personality Inventory).

METHODS

Thirty-three adult patients with asthma (23 female and 10 male) and 20 healthy controls (14 females and 6 males) were enrolled in this study. Psychometric evaluation was made with the Turkish version of the MMPI. The patients were separated into two groups according to the duration of symptoms (recent-onset asthma < 10 years, long-standing asthma ≥10 years).

RESULTS

Patients with asthma compared with control group had significantly higher the rate of clinical elevation on depression, hysteria, psychasthenia and social introversion. Patients with recent-onset asthma compared with long-standing asthma have significantly higher the rate of clinical elevation on depression, hysteria, psychopathic deviate, psychasthenia and social introversion. MMPI mean t score in patients with recent-onset asthma was higher than patients with long-standing asthma. MMPI mean t score in patients with asthma was negatively associated with the symptom duration in multivariate model.

CONCLUSIONS

Patients with asthma have relatively more inactivity, anergia, guilt, pessimism, nonspecific physical complaints, irrational fears and introvert. Patients with long-standing asthma have less psychological distress, suggesting that learned to cope with his illness.

Prevalence of Comorbidities in Asthma and Nonasthma Patients: A Meta-analysis

This study compares the prevalence rates of comorbidities between asthma and nonasthma control patients reported in the literature.Literature was searched in several electronic databases. After the selection of studies by following précised eligibility criteria, meta-analyses of odds ratios were carried out with subgroup and sensitivity analyses.Eleven studies studying 117,548 asthma patients compared with 443,948 non-asthma controls were included in the meta-analysis. The prevalence of cardiovascular comorbidities (odds ratio (OR): [95% CI] 1.90 [1.70, 2.14]; P < 0.00001), cerebrovascular comorbidities (OR 1.44 [1.29, 1.60]; P < 0.00001), obesity (OR 1.51 [1.14, 2.01]; P < 0.00001), hypertension (OR 1.66 [1.47, 1.88]; P < 0.00001, diabetes (OR 1.25 [1.08, 1.44]; P < 0.00001), other metabolic and endocrine comorbidities (OR 1.60 [1.40, 1.83]; P < 0.00001), psychiatric and neurological comorbidities (OR 1.62 [1.44, 1.82]; P < 0.00001), gut and urinary comorbidities (OR 1.91 [1.47, 2.49]; P < 0.00001),), cancer (OR 1.17 [1.10, 1.25]; P < 0.00001), and respiratory comorbidities (OR 5.60 [4.22, 7.44]; P < 0.00001) were significantly higher in the asthma patients in comparison with nonasthma controls.Asthma is associated with significantly higher comorbidities including cardio-/cerebrovascular diseases, obesity, hypertension, diabetes, psychiatric and neurological comorbidities, gut and urinary conditions, cancer, and respiratory problems other than asthma. Respiratory comorbidities are found 5 times more prevalent in asthma than in non-asthma patients.

Significant predictors of poor quality of life in older asthmatics

BACKGROUND

Morbidity and mortality from asthma are high in older adults and quality of life (QOL) might be lower, although standardized measurements of QOL have not been validated in this population.

OBJECTIVE

To determine predictors of asthma-related QOL in older adults.

METHODS

Allergy and pulmonary outpatients (n = 164) at least 65 years old with an objective diagnosis of asthma completed the Mini-Asthma Quality of Life Questionnaire (mAQLQ). Demographics, medical history, and mean value for daily elemental carbon attributable to traffic, a surrogate for diesel exposure, were obtained. Regression analysis was used to determine predictors of mAQLQ scores.

RESULTS

Total mAQLQ (mean ± SD 5.4 ± 1.1) and symptom, emotional, and activity domain scores were similar to those of younger populations, whereas environmental domain scores (4.4 ± 1.7) appeared lower. Poorer mAQLQ scores were significantly associated with emergency department visits (adjusted β [aβ] = -1.3, where β values indicate the strength and direction of association, P < .0001) and with poorer scores on the Asthma Control Questionnaire (aβ = -0.7, P < .0001). Greater ECAT exposure (aβ = -1.6, P < .02), female sex (aβ = -0.4, P < .006), body mass index of at least 30 kg/m(2) (aβ = -0.4, P < .01), gastroesophageal reflux (aβ = -0.4, P < .01), nonatopic status (aβ = -0.5, P < .002), and asthma onset before 40 years of age (aβ = -0.5, P < .004) were significantly associated with poorer mAQLQ scores.

CONCLUSION

The mAQLQ scores in older adults with stable asthma were similar to those in younger populations and were predictive of other measurements of asthma control, verifying that the mAQLQ is an appropriate tool in older adults with asthma. Traffic pollution exposure was the strongest predictor of poorer asthma-related QOL in older adults with asthma.

Respiratory health status and its predictors: a cross-sectional study among coal-based sponge iron plant workers in Barjora, India

OBJECTIVES

During the past decade, coal-based sponge iron plants, a highly polluted industry, have grown rapidly in Barjora, India. The toxic effects of particulate matters and gaseous pollutants include various respiratory diseases. Understanding workers' perception of respiratory health is essential in people-centred healthcare. The aim of the study was to assess their respiratory health status and to determine its predictors.

DESIGN

Cross-sectional study.

SETTING

Coal-based sponge iron plants in Barjora, India.

PARTICIPANTS

258 coal-based sponge iron plant workers.

PRIMARY OUTCOME MEASURE

Respiratory health status was measured using the St. George's respiratory questionnaire (SGRQ) total score. 100 and 0 represent the worst and best possible respiratory health status, respectively.

STATISTICAL ANALYSES

The two-part model (frequency (any worse respiratory health status) and severity (amount of worse respiratory health status)) was developed for the score, as the data were positively skewed with many zeros.

RESULTS

The mean (SD) SGRQ total score was 7.7 (14.5), the median (IQR) was 0.9 (9.0), and the observed range was 0-86.6. The best possible SGRQ total score was reported by 46.9% of workers. Independent predictors of worse respiratory health status were cleaner domestic cooking fuel (coefficient -0.76, 95% CI -1.46 to -0.06, p=0.034) and personal history of any respiratory disease (1.76, 1.04 to 2.47, p<0.001) in case of frequency; and family history of any respiratory disease (0.43, 0.02 to 0.83, p=0.039) and personal history (1.19, 0.83 to 1.54, p<0.001) in case of severity.

CONCLUSIONS

Less than half of the coal-based sponge iron plant workers in Barjora have the best possible respiratory health status. The predictors of worse respiratory health status were identified. The study findings could be taken into consideration in future interventional studies aimed at improving the respiratory health status of these workers.

Predictors of perceived asthma control among patients managed in primary care clinics

OBJECTIVE

To estimate the extent to which symptom status, physical activity, beliefs about medications, self-efficacy, emotional status, and healthcare utilization predict perceived asthma control over a period of 16 months among a primary care population.

METHODS

The current study is a secondary analysis of data from a longitudinal study that examined health outcomes of asthma among participants recruited from primary care clinics. Path analysis, based on the Wilson and Cleary and International Classification of Functioning, Disability and Health frameworks, was used to estimate the predictors of perceived asthma control.

RESULTS

The path analysis identified initial perceived asthma control asthma (β = 0.43, p < 0.0001), symptoms (β = 0.35, p < 0.0001), physical activity (β = 0.27, p < 0.0001), and self-efficacy (β = 0.29, p < 0.0001) as significant predictors of perceived asthma control (total effects, i.e., direct and indirect), while emotional status (β = 0.08, p = 0.03) was a significant indirect predictor through physical activity. The model explained 24 % of the variance of perceived asthma control. Overall, the model fits the data well (χ (2) = 6.65, df = 6, p value = 0.35, root-mean-square error of approximation = 0.02, Comparative Fit Index = 0.999, and weighted root-mean-square residual = 0.27).

CONCLUSION

Initial perceived asthma control, current symptoms status, physical activity, and self-efficacy can be used to identify individuals likely to have good perceived asthma control in the future. Emotional status also has an impact on perceived asthma control mediated through physical activity and should be considered when planning patient management. Identifying these predictors is important to help the care team tailor interventions that will allow individuals to optimally manage their asthma, to prevent exacerbations, to prevent other respiratory-related chronic disease, and to maximize quality of life.

Characteristics of atopic bronchial asthma in seniors over 80 years of age

BACKGROUND

Asthma in the elderly is an important public health problem. The aim of this study was to assess the prevalence and characteristics of asthma in seniors.

MATERIALS AND METHODS

The study involved 105 people of at least 80 years of age (mean age of 84.1 ± 3.9 years) selected from a group of 1860 individuals. Spirometry, the methacholine test, allergy diagnosis, a measurement of exhaled nitric oxide, and administration of the asthma quality of life questionnaire (AQLQ) were performed.

RESULTS

The average morbidity of asthma in the study population of elderly people (at least 80 years of age) was 5.6% (105 people) of the confidence interval (95% CI: 5.1-6.0). In the study group, 34% of the elderly asthmatics had uncontrolled asthma, 47% had partly controlled asthma, and only 24% had fully controlled asthma. Allergy to house dust mites was predominant. The average total score on the AQLQ was 4.12 ± 0.72 (arithmetic mean ± standard deviation) for the seniors, which was significantly lower than the score for the young.

CONCLUSION

The pathogenesis, natural history, and value of the basic diagnostic methods of asthma in the elderly are similar to those observed in younger age groups.

Quality of life, health care utilization, and control in older adults with asthma

BACKGROUND

Older adults with asthma have worse quality of life, asthma control and increased health care utilization than do healthy peers. Factors that contribute to this are currently unknown.

OBJECTIVE

To identify demographic, psychological or physiologic characteristics associated with asthma quality of life, control and health care utilization in older adults.

METHODS

By using a cross-sectional design, subjects older than 65 years with a history of physician-diagnosed asthma were enrolled. Demographic, psychological and physiological characteristics (including spirometry, atopy testing and exhaled nitric oxide) were collected. Correlations between these factors and the mini Asthma Quality of Life Questionnaire, Asthma Control Questionnaire and health care utilization were assessed.

RESULTS

Seventy subjects were enrolled in the study, with a mean age of 73.3 years and mean duration of asthma diagnosis of 28.5 years. Higher depression screening scores and self-reported depression were strongly correlated with poorer quality of life and asthma control after controlling for confounding effects through a regression model. In addition, worse overall functional status was correlated with poorer asthma quality of life (P < .01), presence of atopy was associated with decreased health care utilization (P < .01) and subjects who lived alone were more likely to have unscheduled visits to a physician's office (P = .06).

CONCLUSIONS

Comorbid depression is strongly associated with poorer asthma quality of life and control in older adults. In addition, worse functional status and living alone may be associated with poorer outcomes. Screening for these conditions is important in the care of the elderly asthmatic population.

Depressive symptoms, low adherence, and poor asthma outcomes in the elderly

OBJECTIVE

To examine the impact of depressive symptoms on asthma outcomes and medication adherence in inner-city elderly patients with asthma.

METHODS

Cohort study of elderly asthmatics receiving primary care at three clinics in New York City and Chicago from 1 January 2010 to 1 January 2012. Depressive symptoms were ascertained with the Patient Health Questionnaire (PHQ-9). Outcomes included asthma control (Asthma Control Questionnaire, ACQ), asthma-related quality of life (Asthma Quality of Life Questionnaire, AQLQ), and acute resource utilization (inpatient and outpatient visits). Asthma medication adherence was evaluated using the Medication Adherence Reporting Scale (MARS).

RESULTS

Three hundred and seventeen participants ≥60 years were included in the study (83% women, 30% Hispanic, and 31% Black). In unadjusted analyses, participants with depressive symptoms were more likely to report poor asthma control (p < .001), worse AQLQ scores (p < .001), and higher rates of inpatient asthma-related visits (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.04-3.99). Those with depressive symptoms also reported lower medication adherence (OR: 0.23, 95%CI: 0.10-0.54). Similar results were obtained in analyses adjusting for age, sex, race/ethnicity, income, asthma medication prescription, years with asthma, intubation history, comorbidities, and health literacy.

CONCLUSION

In this cohort of elderly inner-city participants, depressive symptoms were associated with poorer asthma control and quality of life, as well as with lower rates of adherence to controller medications. Future work exploring possible mediators, including adherence, might elucidate the relationship between depression and poorer asthma outcomes in this population.

Factors influencing quality of life in asthmatics--a case-control study

INTRODUCTION

The quality of life (QOL) in persons with asthma is reduced and different factors such as demography, asthma severity and psychiatric comorbidity play an influential role. However, little is known about the interplay of these factors.

OBJECTIVE

To describe QOL in relation to asthma and analyse for the relative impact of asthma severity, psychiatric comorbidity, lifestyle (smoking and obesity) and demographic determinants on QOL in persons with asthma.

METHODS

One thousand one hundred sixty-one subjects from an earlier cohort with and without asthma were sent an asthma screening questionnaire and a generic QOL measuring instrument (15D).

RESULTS

Seven hundred seventy-eight valid responses (67%). QOL was significantly reduced in persons with asthma compared with controls (P = 0.001), almost on all domains of 15D. In the adjusted regression model, asthma severity, depression, female gender and smoking were associated with reduced QOL, suggesting that these factors play an independent role on lowering QOL. Depression did not inflate the relationship between asthma severity and worse QOL, suggesting that asthma severity plays an independent role on everyday life regardless of psychological state.

CONCLUSION

Asthma severity, psychiatric comorbidity, female gender and smoking were identified in this study to be major contributors to decreased QOL in asthmatics. Health professionals should be aware of this complex picture and take these factors into consideration when choosing the proper treatment of asthma patients. Asthma, asthma severity, epidemiology, psychiatric comorbidity, QOL.

Asthma in the elderly

As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological factors. Medication strategies for asthma have been dominantly derived from younger cohorts so that effective medication strategies have usually not been explored in older people. Older people with asthma are very concerned regarding side effects of medication so that adherence to therapeutic regimes is often poor. In addition physical disability can lead to difficulty in accessing treatment and using inhaler devices. Practical strategies to improve asthma outcomes in older people have been studied infrequently and the goals of self-management suitable for younger age-groups may not be applicable in this group. Consequently, asthma in older people is deserving of further attention both to basic mechanisms of disease, precision in diagnosis and effective therapeutic strategies, including those that involve self-management and device use.

Anxiety and depression in asthma

PURPOSE OF REVIEW

there is growing awareness of the correlation between psychological factors, the course of asthma, and the outcomes of asthma treatment. However, the implications of this correlation are still poorly understood. Here, we review the role of anxiety and depression in asthma with a focus on recent literature.

RECENT FINDINGS

recent studies suggest an interaction between behavioral, neural, endocrine, and immune processes and suggest that psychological factors play an active role in the genesis of asthma. Notably, the role of chronic stress has been investigated, including the parental psychological state during pregnancy. There is evidence that in patients with asthma, such stress may induce hyporesponsiveness of the hypothalamus-pituitary-adrenal axis, resulting in reduced cortisol secretion.

SUMMARY

even though it is generally accepted that anxiety and depression are more common in asthmatic patients and that there is a close correlation between psychological disorders and asthma outcomes, such as poorer control of asthma symptoms, the implications and practical consequences of this link remain weak. New studies are introducing an intriguing model of the links between emotional stress, brain centers, the immune system, and the hypothalamus-pituitary-adrenal axis that is far removed from the original concept of 'asthma nervosa'.

Mitochondrial Dysfunction and Oxidative Stress in Asthma: Implications for Mitochondria-Targeted Antioxidant Therapeutics

Asthma is a complex, inflammatory disorder characterized by airflow obstruction of variable degrees, bronchial hyper-responsiveness, and airway inflammation. Asthma is caused by environmental factors and a combination of genetic and environmental stimuli. Genetic studies have revealed that multiple loci are involved in the etiology of asthma. Recent cellular, molecular, and animal-model studies have revealed several cellular events that are involved in the progression of asthma, including: increased Th2 cytokines leading to the recruitment of inflammatory cells to the airway, and an increase in the production of reactive oxygen species and mitochondrial dysfunction in the activated inflammatory cells, leading to tissue injury in the bronchial epithelium. Further, aging and animal model studies have revealed that mitochondrial dysfunction and oxidative stress are involved and play a large role in asthma. Recent studies using experimental allergic asthmatic mouse models and peripheral cells and tissues from asthmatic humans have revealed antioxidants as promising treatments for people with asthma. This article summarizes the latest research findings on the involvement of inflammatory changes, and mitochondrial dysfunction/oxidative stress in the development and progression of asthma. This article also addresses the relationship between aging and age-related immunity in triggering asthma, the antioxidant therapeutic strategies in treating people with asthma.

Shortness of breath as a predictor of depressive symptoms in a community sample of older adults

OBJECTIVES

Physical symptoms are known to be associated with late life depression both cross-sectionally and over time. We attempted to determine if self-reported shortness of breath (SoB) is associated with depressive symptoms at long-term (3-year) follow-up in a community sample of older (65+) adults.

METHODS

A sample of 2926 elderly subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) were evaluated at baseline and at 3-year follow-up. Depressive symptoms were assessed by a modified version of the Center for Epidemiologic Studies-Depression Scale (CES-D) and SoB was assessed by a three-item scale administered at baseline. The analyses were controlled for factors known to be associated with depressive symptoms and SoB. Both bivariate and multivariate analyses were performed.

RESULTS

Eighty-three percent of subjects who experienced SoB survived for three years. Within the analysis sample of those participating at follow-up, 36 percent experienced SoB at baseline. In bivariate analyses, SoB, older age, female sex, history of a heart attack, higher body mass index (BMI), depressive symptoms at baseline, cognitive impairment, and functional impairment were associated with follow-up depressive symptoms. When controlled variables were included in a linear regression model, SoB was a significant predictor of depressive symptoms at follow-up (p < 0.0001) as well as baseline depressive symptoms, sex, BMI, and functional status. No two-way interaction terms with SoB were significant.

CONCLUSIONS

SoB is a significant predictor of depressive symptoms at 3-year follow-up. Given that SoB is a symptom that is responsive to therapeutic intervention, active intervention to relieve the symptom when identified could reduce the incidence of depressive symptoms.

Adherence to asthma therapy in elderly patients

OBJECTIVES

To assess the adherence to antiasthmatic therapy by the use of questionnaire and objective methods in elderly people, as well as to evaluate the association between cognition, depressive symptoms, functional status, and compliance.

METHODS

Patients aged 65 to 102 with chronic asthma under therapy were analyzed retrospectively to evaluate adherence using the Modified Morisky (MM) scale and a visual analog scale (VAS). In the second part of the study, a 1-year monitoring of asthma based on electronic diary and assessment of drug usage was performed. The MM scale and VAS as well as the estimation of cognition, depression symptoms, and functional status were carried out at the beginning and at the end of the observations.

RESULTS

Among 117 participants at the beginning of the study, only 9% and 21% had high adherence to therapy according to the MM scale and VAS, respectively. After 1 year of monitoring, the compliance assessed by the MM scale increased from 3.08 +/- 0.97 to 3.85 +/- 1.01 and by the VAS from 44% +/- 7.8% to 90% +/- 5.9%. Adherence by electronic diary and drug packages was lower than in both MM scale and VAS. Cognition status correlated with the results of MM and VAS tests but did not influence other methods of assessment. There was a statistical correlation between depression symptoms, cognition, and adherence (p >.01) in contrast to functional status. Compliance correlated with asthma control tests and PEFR.

CONCLUSION

Low adherence to antiasthmatic treatment is common in elderly people. Proper monitoring of asthma by the use of diary or assessment of drugs packages with estimation of depression symptoms and cognition status could increase the compliance and asthma control in this group of patients.

Determinants of Quality of Life Among People with Asthma: Findings from the Behavioral Risk Factor Surveillance System

Asthma is a major contributor to impaired quality of life in the U.S. population. Little is known about population-based determinants of quality of life among people with asthma, however. Using data from the 2000 Behavioral Risk Factor Surveillance System, we examined the associations between selected sociodemographic, behavioral, and other determinants and quality of life among 12,111 participants with current asthma. In multiple logistical regression models, three variables--employment status, smoking status, and physical activity--were significantly associated with all measures of impaired quality of life (poor or fair health, > or = 14 physically unhealthy days, > 14 mentally unhealthy days, > or = 14 activity limitation days, or > or = 14 physically or mentally unhealthy days). Education was significantly and inversely related to impaired quality of life for all measures except activity limitation days. Men were less likely than women to report having > or = 14 physically unhealthy days, > or = 14 mentally unhealthy days, or > or = 14 physically or mentally unhealthy days. Compared with whites, Hispanics were more likely to report being in poor or fair health, and African Americans were less likely to report having > or = 14 physically unhealthy days or > or = 14 physically or mentally unhealthy days. In addition, participants with lower incomes were more likely to report impaired quality of life for three measures (general health status, > or = 14 physically unhealthy days, and activity limitation days). The heaviest participants were more likely to be in poor or fair health or to report having more > or = 14 physically unhealthy days, or > or = 14 physically or mentally unhealthy days. Insurance coverage and the time since their last routine checkup were not significantly associated with any of the quality-of-life measures. These results show that three potentially modifiable factors (smoking status, physical activity, body mass index) are associated with quality of life among persons with asthma. Furthermore, among people with asthma, the elderly, women, poorly educated, and low-income participants are especially likely to experience impaired quality of life.

Asthma in older adults

Asthma is underdiagnosed and undertreated in older adults. The classic symptoms, including episodic wheezing, shortness of breath, and chest tightness, are nonspecific in this age group. Older patients may underrate symptoms, and other diseases, such as chronic obstructive pulmonary disease, congestive heart failure, and angina, may have similar presentations. Objective measurements of lung function always should complement the history taking and physical examination. Management of asthma in older adults should include careful monitoring, controlling triggers, optimizing and monitoring pharmacotherapy, and providing appropriate asthma education. Adverse effects to commonly used asthma medications are more common in older adults, and careful monitoring of their use and adverse effects is important.

Influência das variáveis biopsicossociais na qualidade de vida em asmáticos

A asma brônquica é uma doença complexa e interfere com a qualidade de vida desses doentes. Pretendemos, com a presente investigação, estudar a relação das variáveis sócio-demográficas (género, idade e grau de instrução), clínicas (gravidade da doença, duração e tipo clínico) e psicológicas (cognições, emoções e comportamentos) com a qualidade de vida do doente asmático. Cinqüenta doentes asmáticos do Departamento de Pneumologia e Imunoalergologia dos Hospitais da Universidade de Coimbra preencheram cinco questionários de auto-resposta que avaliavam as variáveis psicológicas em estudo. Os dados clínicos relativamente à doença foram igualmente recolhidos.Os nossos resultados revelam-nos que a qualidade de vida se relaciona com um conjunto de variáveis que podemos denominar biopsicossociais (e.g., uma menor qualidade de vida relaciona-se com uma maior idade, menor escolaridade, uma atitude mais negativa face à asma, designada "estigma", cognições disfuncionais e comportamentos/emoções-problema relacionados com a asma). Implicações ao nível do tratamento são apresentadas.

Respiratory findings in a nursing home population

The prevalence of respiratory abnormalities was studied in an elderly nursing home population. This study investigated 475 female and 147 male individuals living in five nursing homes in Zagreb, Croatia. Chronic respiratory symptoms were recorded using the British Medical Research Council questionnaire. Ventilatory capacity was measured with maximum expiratory flow-volume (MEFV) curves on which forced vital capacity (FVC), one-second forced expiratory volume (FEV1), maximum expiratory flow rate at 50% FVC (FEF50), and maximum expiratory flow rate at 25% FVC (FEF25) were measured. A high rate of chronic respiratory illness and symptoms was found in both female and male nursing home residents. The highest rates were for asthma, chronic cough, and for chest tightness. Odds ratios (OR) showed that smoking and the length of employment were significant risk factors among men. Pulmonary function testing demonstrated a decrease in measured values compared to predicted (p<0.01). This was particularly pronounced for FEF50 and FEF25, suggesting obstructive changes in smaller airways. Regression coefficients were significant for smoking and employment primarily for FEF50 and FEF25. Our data suggest that older individuals residing in nursing homes exhibit an excess of respiratory symptoms, and lung function abnormalities. Smoking and past employment are important risk factors for these respiratory findings. Medical surveillance and preventive strategies should be implemented for this high risk population.

Negative mood and quality of life in patients with asthma

The aim of this study was to evaluate the effect of negative mood states at the moment of questionnaire, and other patient and disease characteristics on quality of life (QoL) in patients with asthma. The study groups were composed of 116 stable adult asthmatic patients and 116 age and sex matched healthy subjects. We used Short-Form Health Survey-36 (SF-36) for the assessment of general QoL in all participants, and the Asthma Quality of Life Questionnaire (AQLQ) for the assessment of disease specific QoL in patients with asthma. We evaluated negative mood in all subjects with a questionnaire including six mood subscales in three categories (nervous-anxious, hostile-angry and fearful-panicky). Negative mood scores were not different between asthmatic and comparison groups (p=0.4), but both SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were significantly lower in asthmatic group (p=0.003 and p=0.001, respectively). Multiple linear regression analysis in all study population indicated that both reduced PCS and MCS scores of SF-36 were associated with negative mood score (beta=-0.28, p<0.001 and beta=-0.37, p<0.001, respectively) and with FEV(1)% (beta=0.19, p=0.001 and beta=0.25, p<0.001, respectively) after adjusting for age, female sex, and the presence of asthma. On the other hand, multiple linear regression analysis in patients with asthma revealed that negative mood score and disease severity score were significant predictors for overall score of AQLQ after adjusting for other patient and disease characteristics (beta=-0.17, p=0.008 and beta=-0.64, p<0.001, respectively). The level of negative mood and disease severity in asthmatics significantly impair QoL. Thus, considering that one of the main objectives of health care should be preserving a satisfactory QoL in asthmatics, the presence and seriousness of negative mood and their effects on QoL should be taken into account as part of the clinical evaluation in asthmatics.

How do the psychosocial consequences of ageing affect asthma management?

WHAT WE NEED TO KNOW: How do social, physical and psychological factors affect asthma and asthma management in older people? How can we minimise their impact and enhance quality of life for older people with asthma? Does inequity based on age, sex, socioeconomic status and/or area of residence affect accessibility, quality and effectiveness of care for older people with asthma? What is the extent of undiagnosed and undertreated asthma among older people, and what are the barriers to symptom reporting, diagnosis and treatment? WHAT WE NEED TO DO: Promote equity of access to diagnosis, investigation and treatment across age, sociodemographic and geographic groups. Encourage older people to seek help for symptoms and exacerbations. Encourage quality use of medicines among older people with asthma and comorbid conditions and disabilities. Promote healthy behaviours for older people with asthma (eg, smoking cessation, exercise, vaccination, better nutrition). Develop guidelines that account for complexities of older age and that are framed to achieve optimal quality of life for people with asthma.

Association of asthma-related symptoms with snoring and apnea and effect on health-related quality of life

OBJECTIVES

This study aimed to investigate the association of asthma-related symptoms with snoring and apnea, and to assess their effects on health-related quality of life (HRQL).

DESIGN

Population-based cross-sectional study.

SUBJECTS AND METHODS

A total of 10,224 parents and grandparents of students from 14 randomly selected primary schools in city center were asked to answer questionnaires sent by their children. All subjects were questioned for asthma-related symptoms, sleep-related disorders (snoring and apnea), and for HRQL using the Respiratory Questionnaire, Sleep and Health Questionnaire, and Short Form-12 (SF-12) Health Survey, respectively.

RESULTS

The overall response rate to questionnaires was 97.7%, and all analysis was performed on 7,469 subjects (3,920 women and 3,549 men) who provided sufficient responses to questions. There were 2,713 subjects who reported asthma-related symptoms. The snoring and the observed apnea were more prevalent in subjects with asthma-related symptoms (54.0% vs 41.4%; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.5 to 1.8; p < 0.001) than those without asthma-related symptoms (16.7% vs 7.0%; OR, 2.7; 95% CI, 2.3 to 3.1; p < 0.001), respectively. Asthma-related symptoms were found to be associated with snoring (OR, 1.5; 95% CI, 1.3 to 1.6; p < 0.001) and observed apnea (OR, 2.2; 95% CI, 1.8 to 2.5; p < 0.001) after adjusting for gender, age, body mass index, income, education, and smoking. Also, HRQL was found to be adversely affected by asthma-related symptoms, snoring, and observed apnea (beta = - 0.26, p < 0.001; beta = - 0.07, p < 0.001; and beta = - 0.08, p < 0.001, respectively, for SF-12 overall score) after adjusting for other confounding factors.

CONCLUSION

Present data suggest that there is a link between the sleep-related breathing disorders and asthma-related symptoms. Moreover, the presence of snoring and observed apnea in individuals with asthma-related symptoms causes further impairment in HRQL. The effects on HRQL of coexistence of these three disorders should be supported by clinical studies.

Effects of aging on sensation of dyspnea and health-related quality of life in elderly asthmatics

BACKGROUND AND AIMS

As the awareness of sensory stimuli is often impaired in older subjects, it has been hypothesized that the aging process may influence the perception of dyspnea. This study aimed at evaluating the aging-related difference in perception of spontaneously occurring dyspnea in adult asthmatics and at whether any such aging-related differences have an effect on the health-related quality of life (HRQOL).

METHODS

18 elderly asthmatics (EA) aged >65 years and 20 young asthmatics (YA) (age range 16-44 years) were recruited. In all subjects, 12-month asthma symptom score and respiratory function were recorded. Dyspnea was measured at rest by the Visual Analog Scale (VAS) and HRQOL by the St. George's Respiratory Questionnaire (SGRQ).

RESULTS

Although the groups did not differ for FEV1% predicted, the EA showed lower VAS scores (9.9+/-19.8 mm vs 19.5+/-17.0, p<0.05). As regards HRQOL, only the "Symptom" section of SGRQ showed lesser impairment in EA.

CONCLUSIONS

Aging is associated with blunted sensation of dyspnea. This only partly attenuates the disease-related impairment in quality of life, and other factors are presumed to counterbalance this effect.

Psychological status and quality of life in elderly patients with asthma

The psychological status and quality of life of 70 stable patients with asthma age > or =60 years and 40 age-matched comparison subjects were examined. The patients with long-standing asthma (duration > or = 8 years) had lower quality-of-life scores than those with recent-onset asthma (duration < 8 years). In multivariate linear regression analysis with adjustment for age, gender duration of disease, and level of bronchial hyperreactivity, worse quality of life was predicted by anxiety, depression, and asthma severity scores. In elderly patients with long-standing asthma, disease severity significantly impairs quality of life. Impaired quality of life in these patients may be partly related to psychological status indicators.

Factorial design for the analysis of patient's quality of life in asthma

Chronic diseases like asthma have a great impact on the everyday life of patients. Evaluation of a patient's quality of life informs us about how the patient is feeling and whether or not he or she is able to function physically, socially and emotionally. The objectives of this study were to assess the quality of life of asthmatic patients and to study the influence of age and disease severity, as independent variables, on the patient's quality of life. A 2-factor, 3-level face-centred central composite design was applied to construct a second-order polynomial model describing the effects of age and the severity on the quality of life. The second-order polynomial model was successfully applied to describe the effect of age and asthma severity with good correlation on the quality of life measured by either generic (Visual analogue scale) or disease specific (St George's Respiratory Questionnaire) instruments in the examined subjects. Our findings suggest quality of life may be used as a non-invasive patient-centred monitoring system as a guide for disease management if measured regularly.

Effects of chronic airway disease on health status of geriatric patients

BACKGROUND AND AIMS

The impact of chronic airway disease on the health status of elderly patients is only to some extent explained by indexes of airflow limitation. The present study was designed to assess to what extent: 1) asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis with normal FEV1 (simple bronchitis) differ in their impact on health status; 2) health status depends upon non-respiratory factors.

METHODS

A total of 1601 outpatients over 65-198 with asthma, 228 with COPD, 91 with simple bronchitis, and 1084 with non-respiratory illnesses (control group)--were studied by collection of five health status indexes and multidimensional assessment. Discriminant analysis was used to identify health status profiles of groups. Demographic, anthropometric, clinical and respiratory function correlates of selected health status profiles were identified.

RESULTS

Only 26 and 28% of asthma and COPD patients vs 43% of simple bronchitis and 50% of non-respiratory patients showed group-specific health status profiles. These profiles were characterized by lower 6-min walked distance and greater index of disturbed sleep in asthmatics, and by worse performance on Barthel Index, 6-min walking test and Mini-Mental State Examination in COPD patients. More severe bronchial obstruction, a greater index of comorbidity and a longer occiput-wall distance characterized COPD patients with the worst health status.

CONCLUSIONS

The health status of elderly patients with COPD or asthma is highly heterogeneous. On average, COPD is characterized by more severe physical impairment, and asthma by poorer quality of sleep. Comorbidity and severity of bronchial obstruction, but not age, contribute toward defining a subset of COPD patients with the worst health status.

Self-reported asthma and health-related quality of life: findings from the behavioral risk factor surveillance system

STUDY OBJECTIVES

Few population-based data regarding the impact of asthma on health-related quality of life in the US adult population are available.

DESIGN

Cross-sectional study of participants in 50 states in the United States.

SETTING

Using data from 163,773 adult respondents in the 2000 Behavioral Risk Factor Surveillance System, we examined how self-reported asthma is associated with general self-reported health and four health-related quality-of-life measures.

RESULTS

Participants with self-reported current asthma reported significantly more age-adjusted physically unhealthy days (6.5 days vs 2.9 days, p < 0.001), mentally unhealthy days (5.2 days vs 3.0 days, p < 0.001), days with activity limitation (3.7 days vs 1.6 days, p < 0.001), and unhealthy physical or mental days (10.0 days vs 5.4 days, p < 0.001) in the last 30 days than participants who never had asthma. After adjusting for age, sex, race or ethnicity, educational attainment, employment status, smoking status, physical activity status, and body mass index, the odds ratios among persons with asthma compared with persons who never had asthma, were 2.41 (95% confidence interval [CI], 2.21 to 2.63) for reporting poor or fair self-rated health, 2.26 (95% CI, 2.06 to 2.49) for reporting >or= 14 days of impaired physical health during the previous 30 days, 1.55 (95% CI, 1.40 to 1.72) for reporting >or= 14 days of poor mental health during the previous 30 days, 1.96 (95% CI, 1.73 to 2.21) for reporting >or= 14 activity limitation days, and 1.99 (95% CI, 1.84 to 2.15) for reporting >or= 14 days of physically or mentally unhealthy days during the previous 30 days. Results were consistent for all age groups, for both sexes, and for all race or ethnic groups. Participants who did not currently have asthma, but had it previously, reported having more unhealthy days with all four measures than participants who never had asthma, but fewer than participants who currently had asthma.

CONCLUSIONS

These results provide additional measures to evaluate and monitor the impact of asthma on the health of the US adult population.

An exploratory study of priority information needs in adult asthma patients

The aim of this study was to gain insight into patients' perspectives on key information needs regarding their asthma. Focused conversation-style interviews were conducted with a purposive sample of 32 patients (aged 18-84 years; males=17, females=15) from five sites (four primary care, one secondary care) in North West England. Interviews were tape recorded and transcribed verbatim, then subjected to line-by-line content analysis. Nine core information needs were identified: current medications; new therapies; medication side effects; triggers of an asthma attack; lifestyle issues; asthma causation; effects of asthma; long term outcome; and symptom control. Individual differences in information need were apparent, as were differences according to asthma severity. The findings highlight some of the challenges facing health professionals when information-giving. The study's findings could be used in a clinical context to facilitate discussion or to tailor information, and could also provide a basis for future quantitative studies.

The diagnosis and management of asthma is much tougher in older patients

Half the elderly individuals with asthma have not been diagnosed, yet their quality of life is substantially impaired. Primary care physicians should, therefore, be encouraged to ask about respiratory symptoms in elderly patients, and then perform office spirometry for those with symptoms. Airway obstruction increases the likelihood of asthma, but the lack of a 'significant' acute bronchodilator response is clinically meaningless. Methacholine challenge testing is safe and useful for detecting asthma in patients with normal baseline spirometry. Only one in five life-long smokers ever develops chronic obstructive pulmonary disease, so elderly smokers should also be evaluated for reversible airways obstruction. A normal diffusing capacity test will rule out emphysema in current and former smokers. Elderly individuals whose asthma has been diagnosed are often receiving sub-optimal treatment, resulting in poor asthma control and a high death rate. Co-morbidities (recognized or not) are the rule in elderly patients, and these conditions, or the drugs taken to treat them, may exacerbate asthma. Conversely, bronchodilators and corticosteroids used to treat asthma often worsen co-morbid conditions, such as osteoporosis, ocular disease, and cardiac arrhythmias. Therefore, extra caution is needed when treating elderly asthmatic patients, and objective monitoring of their response to each new asthma medication is important.

Asthma in relation to personality traits, life satisfaction, and stress: a prospective study among 11,000 adults

BACKGROUND

While patients' personality has been thought to affect allergic diseases, the association of asthma and psychological factors is still debated. Stress is believed to predispose to asthma, but no clear evidence of causality has been found. We have studied the role of psychological factors in prevalent as well as in incident asthma cases among the adult population.

METHODS

A total of 11540 adults initially aged 18-45 years responded to three questionnaires in 1975, 1981, and 1990, respectively. The association of psychological factors (including extroversion and neuroticism scales, subjective stress, and life satisfaction) and prevalent asthma was studied, as well as the predisposing effect of these factors on the risk of adult onset asthma. Logistic regression was used for risk calculations.

RESULTS

Low life satisfaction was associated with asthma prevalence (age- and sex-adjusted OR=2.27: 1.04-4.93 for prevalent asthma among those with low life satisfaction compared to those with high life satisfaction), as was neuroticism (age and sex-adjusted OR=1.78:1.12-2.84 for those with a high neuroticism score compared to those with a low score). A high extroversion score was significantly associated with the risk of adult onset asthma among women (age-adjusted OR=2.72: 1.44-5.12 for new asthma among those with high score compared to those with a low extroversion score).

CONCLUSION

No specific personality type is associated with adult onset asthma, but there is a significant sex difference in the effect of psychological factors in asthma risk. A high extroversion score is a strong predictor of incident asthma among women. Prevalent asthma decreases life satisfaction and is associated with a high neuroticism score.

Dyspnoea in the elderly: a clinical approach to diagnosis

This review briefly overviews the pathophysiology of dyspnoea and then focuses on discussion of the most frequent causes of chronic and acute dyspnoea in the elderly. The most common causes of dyspnoea in the elderly include heart failure, chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. Dyspnoea should not be attributed to aging alone. Careful clinical evaluation and spirometry is indicated, and additional testing may be appropriate. In this article, emphasis is placed on the clinical manifestations of dyspnoea in the elderly and an approach to their differential diagnosis is provided. Discussion of available therapy is beyond the scope of this article.

Asthma severity, atopic status, allergen exposure and quality of life in elderly persons

BACKGROUND

Although asthma can be associated with significant airflow obstruction in those over the age of 65, it is often underdiagnosed and undertreated.

OBJECTIVE

To describe severity of asthma, allergy skin test sensitivities, indoor allergen exposures, and the impact on quality of life (QOL) and health status in elderly persons with asthma.

METHODS

A cross-sectional data analysis with 80 elderly persons with asthma recruited from medical, geriatric, and allergy/immunology tertiary care centers. Asthma severity was determined by symptoms and measurements of lung function. House dust specimens were collected from mattresses and bedroom carpets and analyzed separately for the major allergens of house dust, using monoclonal antibody-based immunoenzymetric assays. QOL was measured using Juniper's Asthma Quality of Life Questionnaire. Health status was measured using the Short Form Health Survey Medical Outcome Questionnaire which included Ferrans and Powers' Quality of Life Index subscales.

RESULTS

Two-thirds of participants had either moderate or severe persistent asthma. Skin tests to a battery of common airborne allergens were positive to at least one allergen in 56 of the 75 participants tested (74.7%). Reservoir dust allergen levels were often high enough to place participants at risk of symptoms or at risk of developing sensitization. Increased asthma severity was associated with significantly lower QOL and a trend toward decreased health status.

CONCLUSIONS

Asthma is a significant chronic problem in the elderly. Atopy was common. Asthma severity impacts on these participants' QOL and health status. Results support interventions aimed at identifying allergens precipitating attacks and reducing them in the home.

Late onset asthma: epidemiology, diagnosis and treatment

Asthma is common among older persons, affecting approximately 4 to 8% of those above the age of 65 years. Despite its prevalence, late onset asthma may be misdiagnosed and inadequately treated, with important negative consequences for the patient's health. The histopathology of late onset disease appears to be similar to that of asthma in general, with persistent airway inflammation a characteristic feature. It is less clear, however, that allergic exposure and sensitisation play the same role in the development of disease in adults as they do in children. Atopy is less common among those with late onset asthma, and the prevalence of elevated immunoglobulin E levels is lower among those aged over 55 years of age than younger patients. Occupational asthma is an aetiological consideration unique to adult onset disease, with important implications for treatment. The differential diagnosis for cough, wheeze, and dyspnoea in the elderly is broad, and includes chronic obstructive bronchitis, bronchiectasis, congestive heart failure, lung cancer with endobronchial lesion and vocal cord dysfunction. Keys to accurate diagnosis include a good history and physical examination, the demonstration of reversible airways obstruction on pulmonary function tests and a favorable response to treatment. Inhaled corticosteroid therapy is recommended for patients with persistent disease, and careful instruction in the use of metered-dose inhalers is particularly important for the elderly.