Chest
Volume 116, Issue 3, September 1999, Pages 603-613
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Clinical Investigations
Asthma
Underdiagnosis and Undertreatment of Asthma in the Elderly

https://doi.org/10.1378/chest.116.3.603Get rights and content

Objective

To describe the clinical correlates of asthma in a community-based sample of elderly persons.

Participants

A community sample of 4,581 persons ≥ 65 years old from the Cardiovascular Health Study.

Measurements

Standardized respiratory, sleep, and quality-of-life (QOL) questions, a medication inventory, spirometry, and ambulatory peak flow.

Results

Four percent of the participants reported a current diagnosis of asthma (definite asthma), while another 4% reported at least one attack of wheezing accompanied by chest tightness or dyspnea during the previous 12 months (probable asthma). Smokers and those with congestive heart failure were excluded from the subsequent analyses, leaving 2,527 participants. Of those who had definite asthma, 40% were taking a sympathomimetic bronchodilator, 30% inhaled corticosteroids, 21% theophylline, and 18% oral corticosteroids; 39% were taking no asthma medications. The participants with definite or probable asthma were much more likely than the others to have a family history of asthma, childhood respiratory problems, a history of workplace exposures, dyspnea on exertion, hay fever, chronic bronchitis, nocturnal symptoms, and daytime sleepiness. They were also more likely to report poor general health, symptoms of depression, and limitation of activities of daily living. There was little difference in the morbidity and QOL of participants with recent asthma-like symptoms who had received the diagnosis of asthma versus those who had not.

Conclusions

Asthma in elderly persons is associated with a lower QOL and considerable morbidity when compared with those who do not have asthma symptoms. Asthma is underdiagnosed in this group and is often associated with allergic triggers; inhaled corticosteroids are underutilized.

Section snippets

Recruitment

Participants in the CHS were selected using a Medicare eligibility list (United States citizens ≥ 65 years old) provided by the US Health Care Financing Administration for the four participating communities: Forsyth County, NC; Pittsburgh, PA; Sacramento County, CA; and Washington County, MD. These communities are diverse in proportion of minorities, education and income level, degree of urbanization, death rates, and availability of medical care. An age- and gender-stratified random sample of

Asthma Prevalence

A total of 4,581 participants were seen in the CHS clinics during the year 6 follow-up examination from May 1993 to June 1994. Four percent of all CHS participants reported current (definite) asthma that had been confirmed by a physician (Table 1). An additional 4% reported at least one attack of wheezing with dyspnea or chest tightness during the previous year (probable asthma), and an additional 11% reported wheezing brought on by various exposures (possible asthma). Not included in the

Asthma Prevalence

The CHS is one of the largest population-based examinations of heart and lung disease in elderly persons in the United States. The 6% prevalence of a history of asthma at the CHS baseline examination and 4% prevalence of current asthma during this follow-up examination are similar to the rates reported in subjects > 65 years of age during a postal survey in northern Sweden18 and in Australia.19

The correlates of major respiratory symptoms and obstructive lung diseases in the CHS cohort at the

Participating Institutions and Principal Staff

Forsyth County, NC—Bowman Gray School of Medicine of Wake Forest University: Gregory L. Burke, Alan Elster, Walter H. Ettinger, Curt D. Furberg, Edward Haponik, Gerardo Heiss, Dalane Kitzman, H. Sidney Klopfenstein, Margie Lamb, David S. Lefkowitz, Mary F. Lyles, Maurice B. Mittelmark, Cathy Nunn, Ward Riley, Grethe S. Tell, James F. Toole, and Beverly Tucker; ECG Reading Center—Forsyth County, NC—Bowman Gray School of Medicine: Kris Calhoun, Harry Calhoun, Farida Rautaharju, Pentti Rautaharju,

Classification of Asthma Severity†

Severe Persistent Asthma (GIA Step 4)

  • 1.

    Continuous symptoms: “Do you have trouble with your breathing continuously?” = yes

  • 2.

    Frequent nighttime symptoms: “How frequently have you had these symptoms (chest tightness or breathlessness with wheezing)?” = at least every day or night

  • 3.

    Light physical activities limited by asthma symptoms: “Do you get short of breath with light physical activity, such as… ?” = yes, and “How short of breath do you feel during this activity?” = very or extremely

  • 4.

    FEV1 < 50%

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    Supported by National Heart, Lung, and Blood Institute contract N01–87079.

    A complete list of participants is located in Appendix 1.

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