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Perpiñá M, Gómez-Bastero A, Trisán A, Martínez-Moragón E, Álvarez-Gutiérrez FJ, Urrutia I, Blanco-Aparicio M. Expert consensus recommendations for the management of asthma in older adults. Med Clin (Barc) 2022; 159:53.e1-53.e14. [PMID: 34226059 DOI: 10.1016/j.medcli.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.
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Affiliation(s)
- Miguel Perpiñá
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Andrea Trisán
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - Isabel Urrutia
- Unidad de Asma y Enfermedades Ocupacionales-Medioambientales, Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, España
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Ban GY, Ye YM, Lee Y, Kim JE, Nam YH, Lee SK, Kim JH, Jung KS, Kim SH, Park HS. Predictors of Asthma Control by Stepwise Treatment in Elderly Asthmatic Patients. J Korean Med Sci 2015; 30:1042-7. [PMID: 26240480 PMCID: PMC4520933 DOI: 10.3346/jkms.2015.30.8.1042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/15/2015] [Indexed: 11/22/2022] Open
Abstract
The geriatric population is increasing, and asthma severity increases with age. We determined the predictors of asthma control, exacerbation, and the factors that affect asthma-specific quality of life (A-QOL) in elderly asthmatic patients. This was a prospective, multicenter, real-life study for 6 months with stepwise pharmacologic treatment based on the Global Initiative for Asthma (GINA) guideline. A total of 296 asthmatic patients aged ≥ 60 yr were recruited from 5 university centers in Korea. The improved-asthma control group was defined as the group of patients who maintained well-controlled or improved disease and the not-improved asthma control group was defined as the remaining patients. Fewer number of medications for comorbidities (2.8 ± 3.3 in the improved vs. 4.5 ± 4.4 in the control) and higher physical functioning (PF) scale (89.8 ± 14.2 in the improved vs. 82.0 ± 16.4 in the control) were significant predictors in the improved-asthma control group (OR = 0.863, P = 0.004 and OR = 1.028, P = 0.018, respectively). An asthma control test (ACT) score of ≤ 19 at baseline was a significant predictor of asthma exacerbation (OR = 3.938, P = 0.048). Asthma duration (F = 5.656, P = 0.018), ACT score (F = 12.237, P = 0.001) at baseline, and the presence of asthma exacerbation (F = 5.565, P = 0.019) were significant determinants of changes in A-QOL. The number of medications for comorbidities and performance status determined by the PF scale may be important parameters for assessing asthma control in elderly asthmatic patients.
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Affiliation(s)
- Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yunhwan Lee
- Department of Preventive Medicine & Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Jeong-Eun Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University School of Medicine, Busan, Korea
| | - Soo-Keol Lee
- Department of Internal Medicine, Dong-A University School of Medicine, Busan, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Ban GY, Park HS. Treatment of allergic diseases in elderly. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Abstract
PURPOSE In clinical practice, some patients with asthma show incompletely reversible airflow obstruction, resembling chronic obstructive pulmonary disease (COPD). The aim of this study was to analyze this overlap phenotype of asthma with COPD feature. MATERIALS AND METHODS A total of 256 patients, over the age of 40 years or more with a diagnosis of asthma, based on either 1) positive response to bronchodilator: >200 mL forced expiratory volume in 1 s (FEV₁) and >12% baseline or 2) positive methacholine or mannitol provocation test, were enrolled. Among the asthma patients, we defined the overlap group with incompletely reversible airflow obstruction [postbronchodilator FEV₁/forced vital capacity (FVC)<70] at the initial time of admission and continuing airflow obstruction after at least 3 months follow up. We evaluated clinical features, serum eosinophil counts, serum total immunoglobulin (Ig) E with allergy skin prick test, spirometry, methacholine or mannitol provocation challenges and bronchodilator responses, based on their retrospective medical record data. All of the tests mentioned above were performed within one week. RESULTS The study population was divided into two groups: asthma only (62%, n=159, postbronchodilator FEV₁/FVC≥70) and overlap group (38%, n=97, postbronchodilator FEV₁/FVC<70). The overlap group was older, and contained more males and a higher percentage of current or ex-smokers than the asthma only group. Significantly lower FEV₁ and higher total lung capacity, functional residual capacity, and residual volume were observed in the overlap group. Finally, significantly lower serum eosinophil count and higher IgE were seen in the overlap group. CONCLUSION Our results showed that the overlap phenotype was older, male asthmatic patients who have a higher lifetime smoking intensity, more atopy and generally worse lung function.
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Affiliation(s)
- Hea Yon Lee
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Kang
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung Kyu Yoon
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Young Lee
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Suk Kwon
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chin Kook Rhee
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Al-Alawi M, Hassan T, Chotirmall SH. Advances in the diagnosis and management of asthma in older adults. Am J Med 2014; 127:370-8. [PMID: 24380710 DOI: 10.1016/j.amjmed.2013.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
Global estimates on aging predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis, and management in clinical practice require optimization. This review aims to provide an update for clinicians, highlighting advances in the understanding of the aging process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Aging impacts airway responses and immune function, and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence, and side-effect profiles persist in the older patient, while novel recording devices developed to aid detection of an adequate inhalation evaluate treatment effectiveness and compliance more accurately than previously attainable. Anticytokine therapies improve control of brittle asthma, while bronchial thermoplasty is an option in refractory cases. Multidimensional intervention strategies prove best in the management of asthma in the older adult, which remains a condition that is not rare but rarely diagnosed in this patient population.
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Affiliation(s)
- Mazen Al-Alawi
- Department of Medicine, Our Lady of Lourdes Hospital, Navan, Republic of Ireland
| | - Tidi Hassan
- Department of Respiratory Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Republic of Ireland
| | - Sanjay H Chotirmall
- Department of Medicine, St James's Hospital, James's Street, Dublin 8, Republic of Ireland.
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Milgrom H, Huang H. Allergic disorders at a venerable age: a mini-review. Gerontology 2013; 60:99-107. [PMID: 24334920 DOI: 10.1159/000355307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022] Open
Abstract
This review focuses on 3 allergic disorders of persons coming up against venerable age: asthma, allergic rhinitis, and atopic dermatitis. The prevalence of allergic diseases in the elderly ranges from 5 to 10% and appears to be rising. A gradual decline in immune function, termed immunosenescence, and age-related changes in tissue structure influence the development of these disorders. Common complications are comorbidities, polypharmacy, and adverse effects of drugs. The elderly have difficulty mounting protective immune responses against newly encountered antigens. The integrity of epithelial barriers is compromised, leading to a chronic, subclinical inflammatory state and an enhanced Th2 (allergic) immune response. Undiagnosed asthma is frequent in elderly persons (about 8%) and still more commonplace in those with respiratory symptoms. Poorly controlled asthma in the elderly undermines their functional status and leads to a loss of autonomy and social isolation that may delay seeking medical services. Aggravation of allergic rhinitis coincides with exacerbation of asthma, whereas treatment of nasal inflammation improves control of the asthma. Atopic dermatitis is a chronically relapsing inflammatory skin disease often associated with respiratory allergy.
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Affiliation(s)
- Henry Milgrom
- Department of Pediatrics, National Jewish Health, University of Colorado School of Medicine, Denver, Colo., USA
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Asthma Control and Its Relationship with Obstructive Sleep Apnea (OSA) in Older Adults. SLEEP DISORDERS 2013; 2013:251567. [PMID: 24307949 PMCID: PMC3836422 DOI: 10.1155/2013/251567] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023]
Abstract
Background/Objectives. Asthma in older individuals is poorly understood. We aimed to characterize the older asthma phenotype and test its association with obstructive sleep apnea (OSA). Design. Cross-sectional. Setting. Pulmonary and Asthma/Allergy clinics. Participants. 659 asthma subjects aged 18–59 years (younger) and 154 aged 60–75 (older). Measurements. Sleep Apnea scale of Sleep Disorders Questionnaire (SA-SDQ), asthma severity step (1–4, severe if step 3 or 4), established OSA diagnosis, continuous positive airway pressure (CPAP) use, and comorbidities. Results. Older versus younger had worse control, as assessed by asthma step, lung function, and inhaled corticosteroid use. Among older subjects, after controlling for known asthma aggravators, OSA diagnosis was the only factor robustly associated with severe asthma: on average, OSA was associated with nearly 7 times greater likelihood of severe asthma in an older individual (OR = 6.67). This relationship was of greater magnitude than in younger subjects (OR = 2.16). CPAP use attenuated the likelihood of severe asthma in older subjects by 91% (P = 0.005), much more than in the younger asthmatics. Conclusion. Diagnosed OSA increases the risk for worse asthma control in older patients, while CPAP therapy may have greater impact on asthma outcomes. Unrecognized OSA may be a reason for poor asthma control, particularly among older patients.
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Park HW, Kwon HS, Kim TB, Kim SH, Chang YS, Jang AS, Cho YS, Nahm DH, Park JW, Yoon HJ, Cho YJ, Choi BW, Moon HB, Cho SH. Differences between asthma in young and elderly: results from the COREA study. Respir Med 2013; 107:1509-14. [PMID: 23927852 DOI: 10.1016/j.rmed.2013.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND There has been no large-scale and comprehensive study of the differences between asthma in elderly asthmatics (EA) and non-elderly (i.e. young) asthmatics (NEA). METHODS We performed principal component analysis (PCA) using 2067 asthmatics (434 EA and 1633 NEA) from the Korean Cohort for Reality and Evolution of adult Asthma (COREA). EA was defined as asthmatics with the chronological age of 65 or more and eleven clinical variables measured at enrollment were used for PCA; symptom score, symptom duration, number of exacerbation during previous one year, smoking pack year, number of controller medications, body mass index, predicted % of FEV1, predicted % FVC, post-bronchodilator FEV1/FVC ratio, atopy index and number of eosinophils in peripheral blood. RESULTS PCA of all asthmatics showed that EA and NEA were distinctly separated by the first and second principal component on the plot of individual asthmatics according to their scores. For further analysis, we divided all asthmatics into the EA and the NEA group and performed PCA again in each group. The first four principal components with eigenvalues ≥ 1.0 were identified in both groups and they explained 55.5% of the variance in the EA group and 52.4% in the NEA group respectively. Clinical variables showed distinctly different patterns of loading on the first four principal components between the EA and the NEA group. CONCLUSION EA and NEA have different compositional patterns underlying their clinical variables. These observations helped in understanding the differences between EA and NEA from the integrated view covering various clinical aspects.
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Affiliation(s)
- Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Hsiao HJ, Wang LC, Yang YH, Lee JH, Yu HH, Lin YT, Chiang BL. A nationwide survey of the severity, comorbidity, and mortality of hospitalized patients with asthma in Taiwan. Pediatr Neonatol 2013; 54:254-60. [PMID: 23597519 DOI: 10.1016/j.pedneo.2013.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/30/2012] [Accepted: 01/29/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To clarify the epidemiology of asthma admission in a nationwide survey, we analyze the characteristics of hospitalized patients in Taiwan. METHODS Data regarding asthma-associated hospitalizations were obtained from the National Health Insurance Research Database of Taiwan from January 2001 to December 2002. Patient characteristics in terms of severity, mortality, and cost were stratified by age, gender, and presence of comorbidities. RESULTS A total of 59,983 hospitalizations with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 493.xx and asthma-related treatment were included in the current analysis. When stratified by age, the number and duration of hospitalizations were distributed in J-shape distribution, with the nadir located in the range of 8-18 years of age. The severity of asthma was found to increase with age (p < 0.001) and was more severe in men compared with women (p < 0.001). The severity of in-hospital patients was significantly greater in subjects with underlying respiratory disease compared to patients with other comorbidities, such as cardiovascular disease and infectious disease. The mortality rates of all hospitalized asthma patients and pediatric hospitalized asthma patients were 0.77% and 0.02%, respectively. The risk factor for mortality of asthma was older age and male gender in multiple regression. CONCLUSION The severity of asthma increased after 18 years of age. Increased comorbidities in elderly patients might contribute to asthma severity. The mortality rate was low in pediatric patients and significantly increased in males and the elderly. The above findings suggest that additional effort is required in the treatment of elderly and male asthmatic patients.
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Affiliation(s)
- Hui-Ju Hsiao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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Davis E, Coover K, Morrow L, Malesker M. Differentiating the treatment of asthma and chronic obstructive pulmonary disease in the elderly patient. ACTA ACUST UNITED AC 2012; 27:650-9. [PMID: 22982749 DOI: 10.4140/tcp.n.2012.650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The focus of this case is a 70-year-old female who was admitted to an assisted living community following a hospitalization for a severe asthma exacerbation. The diagnosis of asthma in the geriatric patient is often under-recognized, misdiagnosed, and improperly managed. Several factors may explain the misclassification and the undertreatment of asthma in the older patient. This case discusses the pharmacotherapeutic management of asthma in the geriatric patient and differentiates the clinical features of asthma from that of chronic obstructive lung disease. The comprehensive management of asthma should include an interprofessional approach because the consultant pharmacist is an essential member of the health care team.
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Affiliation(s)
- Estella Davis
- Creighton University School of Pharmacy and Health Professions, Omaha, NE 68178, USA.
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Hanania NA, King MJ, Braman SS, Saltoun C, Wise RA, Enright P, Falsey AR, Mathur SK, Ramsdell JW, Rogers L, Stempel DA, Lima JJ, Fish JE, Wilson SR, Boyd C, Patel KV, Irvin CG, Yawn BP, Halm EA, Wasserman SI, Sands MF, Ershler WB, Ledford DK. Asthma in the elderly: Current understanding and future research needs--a report of a National Institute on Aging (NIA) workshop. J Allergy Clin Immunol 2011; 128:S4-24. [PMID: 21872730 PMCID: PMC3164961 DOI: 10.1016/j.jaci.2011.06.048] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Asthma Clinical Research Center, Baylor College of Medicine, Houston, Tex., USA
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Abstract
BACKGROUND Asthma is a highly prevalent chronic disease. Prevalence and mortality are particularly high in Puerto Ricans living in the United States as compared with other populations. OBJECTIVE To determine asthma mortality rates in Puerto Rico (1980-2007) and to assess the sociodemographic variables that may be associated with these rates. METHODS Data were obtained from the Vital Statistics Office at the Puerto Rico Department of Health. Crude mortality rates (CMRs) and their 95% confidence intervals (95% CIs) were used to evaluate differences between age groups and across years. Mortality risk ratios (RRs) by sociodemographic variables were estimated using generalized lineal models with a Poisson link function to identify at-risk groups. RESULTS During the study period, there were 4232 deaths recorded with asthma as the cause of death. From 1980 to 1998, annual asthma mortality rates fluctuated between 3.32 and 6.56 deaths per 100,000 (mean 4.77), followed by a decline after implementation of the ICD-10 for reporting cause of death in 1999. Between 1999 and 2007, the mean asthma death rate declined to 3.01 (4.89 in 1999 to 2.02 in 2007). Overall, asthma mortality rates were between 1.77 and 4.0 times higher in Puerto Rico than in the United States. Throughout the whole study period, mortality rates were higher in older age groups. In addition, the adjusted regression model for asthma deaths showed that persons divorced or widowed, and persons with only elementary education had significantly higher risk of asthma mortality than their counterparts. CONCLUSION Asthma death rates were higher in Puerto Rico than in the United States general population. Although asthma mortality in Puerto Rico declined, rates continued to be significantly higher than those recorded in the United States. There was a progressive decline in asthma mortality rates after 1999 that may be explained by changes in reporting classification, increased use of corticosteroids, and improved asthma awareness. After controlling for possible confounding variables, age and elementary education were found to increase the risk of mortality due to asthma among Puerto Ricans.
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Urso DL. Asthma in the elderly. Curr Gerontol Geriatr Res 2009; 2009:858415. [PMID: 19888424 PMCID: PMC2771152 DOI: 10.1155/2009/858415] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 07/08/2009] [Accepted: 09/10/2009] [Indexed: 11/17/2022] Open
Abstract
Bronchial asthma is a common problem with enormous medical and economics impacts. It is an inflammatory disease of the airways associated with intermittent episodes of bronchospasm. Asthma is not uncommon in the elderly patients. Prevalence of asthma is similar in older and younger adults. Asthma in the elderly patient is underdiagnosed because of false perceptions by both patient and physician. The high incidence of comorbid conditions in the elderly patient makes the diagnosis and management more difficult. Correct diagnosis is demonstrated with spirometry. The goals of asthma treatment are to achieve and maintain control of symptoms and to prevent development of irreversible airflow limitation. Asthma drugs are preferably inhaled because this route minimizes systemic absorption and, thus, improves the ratio of the therapeutic benefit to the potential side-effects in elderly patients.
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Respiratory Symptom Reporting Error in Occupational Surveillance of Older Farmers. J Occup Environ Med 2009; 51:472-9. [DOI: 10.1097/jom.0b013e3181973de5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goeman DP, Douglass JA. Optimal management of asthma in elderly patients: strategies to improve adherence to recommended interventions. Drugs Aging 2007; 24:381-94. [PMID: 17503895 DOI: 10.2165/00002512-200724050-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adherence to asthma medications presents a problem in all age groups, and older people with chronic illnesses such as asthma also have multiple co-morbidities and consequently complex healthcare needs. It has been suggested that older people are also less likely to adhere to medication and treatment than younger people. Although the prevalence of asthma in older people is similar to that of the general population, over two-thirds of those who die from asthma are >50 years of age and there is strong evidence for under-diagnosis. Clinicians therefore face specific challenges in providing healthcare with respect to both asthma diagnosis and treatment in older age groups. Non-adherence to medication can be defined as either 'intentional' or 'unintentional'. Unintentional non-adherence is more likely to be associated with sociodemographic or physical barriers to the use of medication. Intentional non-adherence results from the balance of individual reasoning of risks versus the benefits of taking medication and acceptance of asthma diagnosis. Intentional non-adherence can be addressed through strategies that influence health beliefs and concerns about the adverse effects of medicine. Unintentional adherence can be addressed by assessing and educating the patient in relation to device use and providing education and clear written instructions about medication requirements. However, some barriers to medication use, such as financial ones, may be systematic. Most studies of medication use, efficacy, adverse effects and adherence in patients with asthma primarily involve younger people. Studies of strategies to improve asthma adherence outcomes specifically in older people are urgently needed.
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Affiliation(s)
- Dianne P Goeman
- Co-operative Research Centre for Asthma and Airways, AIRmed, The Alfred Hospital, Melbourne, Victoria, Australia.
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Ahmed S, Ernst P, Tamblyn R, Colman N. Validation of The 30 Second Asthma Test as a measure of asthma control. Can Respir J 2007; 14:105-9. [PMID: 17372638 PMCID: PMC2676381 DOI: 10.1155/2007/340596] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The primary objective of asthma management is to help patients establish and maintain optimal disease control. Simple and efficient tools are needed to assess patient-reported symptoms so that they can be used with or without airway function to evaluate asthma control. OBJECTIVE The objective of the present study was to evaluate the validity of The 30 Second Asthma Test (GlaxoSmithKline Inc, Canada), based on the Canadian Asthma Guidelines, by estimating its relationship with criterion measures of control. RESULTS The discriminative and diagnostic validity of The 30 Second Asthma Test was examined in a sample of 81 patients with a confirmed diagnosis of asthma. Based on a cut-off score of two or greater on The 30 Second Asthma Test, the overall agreement with specialist ratings was 65%, and 58% with per cent predicted forced expiratory volume in 1 s. The 30 Second Asthma Test scores distinguished between groups of patients who were classified based on the change in intensity of therapy. CONCLUSION The results support the use of The 30 Second Asthma Test as a brief screening tool for asthma control.
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Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, McGill University, Montreal, Canada.
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Slavin RG, Haselkorn T, Lee JH, Zheng B, Deniz Y, Wenzel SE. Asthma in older adults: observations from the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) study. Ann Allergy Asthma Immunol 2006; 96:406-14. [PMID: 16597074 DOI: 10.1016/s1081-1206(10)60907-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) was a 3-year, multicenter, observational study of 4,756 patients 6 years or older with severe or difficult-to-treat asthma by physician evaluation. More than 280 pulmonologist and allergist sites across the United States participated. OBJECTIVE To compare health care utilization (HCU), medication use, asthma control, and quality of life (QoL) in older (> or =65 years; n = 566) and younger (18-64 years; n = 2,912) adult patients in TENOR. METHODS Patients had to be under a physician's care for at least 1 year and have high medication use or HCU in the past year. Heavy smokers (> or =30 pack-years) and patients with cystic fibrosis were excluded. RESULTS Although older patients in TENOR had worse lung function as measured by decreased percent predicted forced expiratory volume in 1 second (FEV1) (P < .001), they had significantly lower HCU compared with younger patients. They also had higher use of inhaled corticosteroids and better QoL than younger patients. Older patients reported fewer problems controlling their asthma (P < .001) but reported worse communication with their physicians (P = .02). CONCLUSIONS Older patients in TENOR appeared to do better than younger patients, despite having worse lung function. Older patients in TENOR may have received more aggressive care than older asthmatic patients in other studies, based on a higher use of inhaled and oral corticosteroids. Whether differences in treatment or disease influenced other physiologic or inflammatory outcomes that contribute to the disconnect between HCU and FEV1 awaits further study.
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Affiliation(s)
- Raymond G Slavin
- Department of Internal Medicine, Division of Allergy and Immunology, Saint Louis University School of Medicine, St Louis, Missouri 63104, USA.
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Abstract
A systematic review of English and Korean articles published between 1990 and 2004 and a search of database and various online resources was conducted to determine the prevalences, mortality rates, socioeconomic burden, quality of life, and treatment pattern of asthma in Korean adults and children. Asthma morbidity and mortality in Korea are steadily increasing. The prevalence of asthma in Korea is estimated to be 3.9% and its severity is often underestimated by both physicians and patients. Mortality resulting from chronic lower respiratory diseases including asthma increased from 12.9 to 22.6 deaths per 100,000 of the population between 1992 and 2002. Disease severity, level of control, and symptom state were all found to negatively impact the quality of life of asthmatics. Although international and Korean asthma management guidelines are available, familiarity with and implementation of these guidelines by primary care physicians remain poor.
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Affiliation(s)
- Sang Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea.
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Jenkins CR, Thompson PJ, Gibson PG, Wood-Baker R. Distinguishing asthma and chronic obstructive pulmonary disease: why, why not and how? Med J Aust 2006; 183:S35-7. [PMID: 15992321 DOI: 10.5694/j.1326-5377.2005.tb06916.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 03/29/2005] [Indexed: 11/17/2022]
Abstract
WHAT WE NEED TO KNOW: What are the essential differences in the inflammatory process that lead to different pathological outcomes in asthma and chronic obstructive pulmonary disease (COPD)? What factors cause some patients with asthma to have clinical features indistinguishable from COPD, and should these patients be treated differently from those with early-onset, atopic asthma? What should be added to FEV(1) improvement after bronchodilator to enhance the ability of spirometry to distinguish between asthma and COPD? Why is disturbed gas exchange characteristic of stable COPD but rare in asthma? Why and when does COPD become a systemic disease with multiorgan dysfunction, while asthma generally does not? Does the response to bronchodilators in asthma and COPD predict prognosis and response to other interventions? Do people with asthma (airway obstruction, hyper-responsiveness and atopy) and COPD (fixed airflow limitation) have different natural histories, responses to treatment and prognoses? WHAT WE NEED TO DO: Evaluate new diagnostic tools (eg, indirect markers of inflammation) for asthma and COPD. Target older people in epidemiological studies to identify and describe the extent of asthma. Initiate community awareness programs to help older people with dyspnoea recognise they may have symptoms of asthma or COPD that should be assessed by a doctor. Define the clinical and physiological features of asthma and COPD in older people that indicate when and which treatments will achieve maximum benefit with least harm. Develop strategies for better, patient-focused care of people with severe airway disease, concentrating on device use, action plans, side effects, end-of-life decisions, exercise and independence in activities of daily living. Maintain research into new drugs and targets for preventing progressive loss of lung function in asthma and COPD.
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Affiliation(s)
- Christine R Jenkins
- Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, PO Box M77, Missenden Road, Camperdown, NSW 2050, Australia.
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20
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Goeman DP, Douglass JA. Understanding asthma in older Australians: a qualitative approach. Med J Aust 2006; 183:S26-7. [PMID: 15992317 DOI: 10.5694/j.1326-5377.2005.tb06912.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 03/30/2005] [Indexed: 11/17/2022]
Abstract
WHAT WE NEED TO KNOW: Are there differences in symptom interpretation in older people with asthma? What are effective drug delivery strategies in older people to maximise adherence and minimise side effects? How do older people with asthma manage their asthma? Are self-management strategies as appropriate as they are in younger age groups? Do older people with asthma take appropriate steps in an emergency? Do they own or act on asthma action plans? WHAT WE NEED TO DO: Identify the specific barriers that prevent the optimal care of older people with asthma. Address systematic barriers, such as cost and immobility, that reduce access to effective treatments. Ensure older people with asthma receive appropriate asthma treatment. Explore asthma self-management strategies in older people to develop effective algorithms. Educate health professionals to provide optimal asthma treatments and deliver appropriate education designed specifically for older people.
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Affiliation(s)
- Dianne P Goeman
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Commercial Road, Prahran, VIC 3181, Australia.
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McCoy L, Redelings M, Sorvillo F, Simon P. A multiple cause-of-death analysis of asthma mortality in the United States, 1990-2001. J Asthma 2006; 42:757-63. [PMID: 16316870 DOI: 10.1080/02770900500308189] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Most analyses of asthma mortality in the United States have relied solely on underlying cause-of-death data, which may underestimate the magnitude of asthma-related mortality. We used multiple cause-of-death data to examine asthma-related mortality trends in the United States. METHODS Data were selected from the United States Multiple Cause-of-Death Files, 1990-2001. Mortality rates and 95% confidence intervals were computed to examine differences in asthma mortality over time and by age, race/ethnicity, and gender. Location of death and seasonal variations in asthma mortality were also assessed, as well as the impact of seasonal respiratory infections. RESULTS We identified 135,668 asthma-related deaths in the United States over the 12-year period, representing an age-adjusted mortality rate of 4.4 per 100,000. Only 45% of the asthma-related deaths had asthma recorded as the underlying cause. Whites and older adults were less likely to have asthma listed as the underlying cause. Asthma mortality rates mirrored underlying cause trends, increasing slightly between 1990 and 1995, declining between 1996 and 1998, and further declining after International Classification of Disease (ICD)-10 implementation in 1999. Mortality was highest among blacks and the elderly and was higher among females than males. Asthma-related deaths peaked in the winter months and were over four times more likely than non-asthma deaths to have acute upper respiratory infections, influenza, or acute bronchitis listed on the death record. The proportion of asthma-related deaths occurring outside a medical setting increased steadily over the period, from 23.3% in 1990 to 29.4% in 2001. CONCLUSIONS The burden of asthma may be underestimated by relying solely on underlying cause-of-death data. Further research is needed to determine the reasons for the steady increase in out-of-hospital deaths and the continued demographic disparities in mortality.
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Affiliation(s)
- Lucie McCoy
- Los Angeles County Department of Health Services, Los Angeles, California, USA.
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Decramer M, Selroos O. Asthma and COPD: differences and similarities. With special reference to the usefulness of budesonide/formoterol in a single inhaler (Symbicort) in both diseases. Int J Clin Pract 2005; 59:385-98. [PMID: 15853852 DOI: 10.1111/j.1368-5031.2005.00509.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) both have a high prevalence worldwide and yet each condition remains underdiagnosed. Despite a number of common features, these inflammatory respiratory syndromes have distinct clinical outcomes. COPD represents a greater economic burden than asthma because it has a less favourable prognosis and is associated with greater morbidity and mortality. Therefore, it is important to distinguish between these two diseases at an early stage, so that appropriate therapy can be prescribed to prevent deterioration. However, effective treatments that may be used in both conditions can minimise the effects of misdiagnosis and maximise the impact of treatment without the associated complexity when both conditions occur together. The current review summarises the differences and similarities of asthma and COPD, in terms of risk factors, pathophysiology, symptoms and diagnosis, to provide greater understanding of the role of budesonide/formoterol in a single inhaler in both diseases.
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Affiliation(s)
- M Decramer
- Respiratory Division, U.Z. Gasthuisberg, Katholieke University, Leuven, Belgium.
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