Asthma and older people in general practice

Chronic disease co-morbidity of asthma and unscheduled asthma care among adults: results of the national telephone health interview survey German Health Update (GEDA) 2009 and 2010

Background:

Co-morbidities may complicate the clinical management of chronic conditions such as asthma.

Aims:

To quantify the strength of the relationship between asthma and other chronic diseases and to analyse whether co-morbidities contribute to unscheduled asthma care.

Methods:

Data from two consecutive national telephone health interview surveys (GEDA 2009 and 2010) including a total of 43,312 adults (≥18 years of age) were analysed. Persons with and without a current diagnosis of asthma were compared with respect to concurrent diagnoses (diabetes mellitus, hypertension, chronic heart failure, depression, osteoarthritis, stroke, coronary heart disease, and cancer). Logistic regression models were applied to assess the strength of the association between asthma and co-morbidities in the total study population and, among persons with asthma, between the number of co-morbidities and unscheduled inpatient (hospital admissions and/or emergency department admissions) or outpatient asthma care in the past 12 months.

Results:

Overall, 5.3% (95% CI 5.0% to 5.6%) of adults reported current physician-diagnosed asthma. Asthma was significantly associated with most of the conditions considered and 18% of persons with asthma had three or more co-morbidities. Adjusted odds ratios (AOR) of unscheduled asthma care increased with numbers of conditions, with AOR 3.40 (95% CI 1.39 to 8.31) for unscheduled inpatient care and AOR 2.32 (95% CI 1.30 to 4.14) for unscheduled outpatient care comparing those with three or more co-morbidities versus those with none.

Conclusions:

The magnitude of chronic disease co-morbidity is substantial in asthma, is related to unscheduled asthma care, and implies a significant number of adults with asthma facing complex healthcare needs.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

PRACTICAL IMPLICATIONS

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

Promoting Asthma Awareness to Older Adults

The limited existing research on the asthma perceptions of older adults suggests that this population perceives asthma to be a childhood disease and, therefore, believe that they are not susceptible to developing the condition as an adult. The asthma mortality rate is much higher for older adults than for children, and there is considerable negative impact on health-related quality of life. However, health promotion regarding asthma is rarely aimed at this population. To address this issue, social marketing campaign messages and materials about asthma were developed for an older adult population based on quantitative survey data. Through a series of community focus groups, these messages and materials were pretested with older adults to establish the types of asthma health promotion messages, taglines, and images that engage this target audience. Materials that conveyed a “human element” appealed most to older adults, enabling them to relate to the individuals and situations depicted in the images. Positive, empowering messages containing novel information and asking questions of the target population resonated best with older adults. These features should be considered in the development of health promotion campaign materials about chronic disease targeting older adult populations.

Asthma in older adults

Asthma in older people is common and is characterised by underdiagnosis and undertreatment. Ageing is associated with unique issues that modify expression, recognition, and treatment of the disease. In particular, asthma and chronic obstructive pulmonary disease (COPD) both overlap and converge in older people. This concurrence, together with absence of precise diagnostic methods, makes diagnosis complex. A multidimensional assessment that addresses airway problems, comorbidities, risk factors, and management skills will draw attention to key needs for intervention. Increased attention to the complications of asthma and obstructive airway disease in older people is needed, specifically to develop effective systems of care, appropriate clinical practice guidelines, and a research agenda that delivers improved health outcomes.