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Respir Med. 2014 Aug;108(8):1091-9. doi: 10.1016/j.rmed.2014.05.016. Epub 2014 Jun 9.

Asthma control in elderly asthmatics. An Italian observational study.

Author information

1
Struttura Complessa di Pneumologia, Azienda Sanitaria Locale 2 Savonese, Pietra Ligure, Italy. Electronic address: manlio.milanese@unige.it.
2
Struttura Complessa di Pneumologia Ospedale S. Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
3
Struttura Complessa di Pneumologia, Fondazione IRCCS Policlinico San Matteo, Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy.
4
Allergologia e Immunologia Clinica Università di Torino, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy.
5
Pneumologia, Azienda Ospedale Misericordia, Grosseto, Italy.
6
Struttura Complessa di Fisiopatologia Respiratoria, Azienda Ospedaliera di Padova, Padova, Italy.
7
Struttura Complessa di Pneumologia, Azienda Ospedaliera Carlo Poma di Mantova, Mantova, Italy.
8
Servizio di Allergologia, Medicina del Lavoro, Azienda Ospedaliera Università degli Studi di Padova, Padova, Italy.
9
Fisiopatologia Respiratoria, Medicina del Lavoro, Università di Padova, Padova, Italy.
10
DIBIMIS, Università degli Studi di Palermo, Palermo, Italy.

Abstract

BACKGROUND:

The exponential increase of individuals aged >64 yrs is expected to impact the burden of asthma. We aimed to explore the level of asthma control in elderly subjects, and factors influencing it.

METHODS:

A multicenter observational study was performed on consecutive patients >64 years old with a documented physician-diagnosis of asthma. Sixteen Italian centers were involved in this 6-month project.

FINDINGS:

A total of 350 patients were enrolled in the study. More than one-third of elderly asthmatic patients, despite receiving GINA step 3-4 antiasthmatic therapy, had an Asthma Control Test score ≤19, with a quarter experiencing at least one severe asthma exacerbation in the previous year. Twenty-nine percent of patients (n = 101) were classified as having Asthma-COPD Overlap Syndrome (ACOS) due to the presence of chronic bronchitis and/or CO lung diffusion impairment. This subgroup of patients had lower mean Asthma Control Test scores and more exacerbations compared to the asthmatic patients (18 ± 4 compared to 20 ± 4, p < 0.01, and 43% compared to 18%, p < 0.01, respectively). Modified Medical Research Council dyspnea mMRC scores and airway obstruction, assessed on the basis of a FEV(1)/FVC ratio below the lower limit of normal, were more severe in ACOS than in asthma, without any difference in responses to salbutamol. In a multivariate analysis, the mMRC dyspnea score, FEV(1)% of predicted and the coexistence of COPD were the only variables to enter the model.

INTERPRETATION:

Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control.

KEYWORDS:

Asthma; Asthma control test; Elderly

PMID:
24958604
DOI:
10.1016/j.rmed.2014.05.016
[Indexed for MEDLINE]
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