ASTHMA IN THE ELDERLY - UNDERPERCEIVED, UNDERDIAGNOSED AND UNDERTREATED - A COMMUNITY SURVEY

Bronchial asthma is now increasingly recognized in the elderly and is associated with significant morbidity and mortality. The aims of this study were two-fold: first, to assess the prevalence and, second, to e valuate diagnostic awareness, therapeutic management and patient perce ption of bronchial asthma among elderly patients in the community. Fro m the age-sex register of an urban general practice in NE England, 200 4 patients aged >65 years were eligible for inclusion. Response to an initial screening questionnaire on respiratory symptomatology was 68% (n = 1362). Of these, 869 patients had respiratory symptoms: 390 volun tarily agreed to be evaluated further including assessment of airway p hysiology. In this group 369/390 had obstructive spirometry and, of th ese, 95 patients fulfilled clinical and physiological criteria of bron chial asthma. Prevalence of asthma within this age cohort was minimall y and rather crudely assigned at 4.5% (95/2004). Among the 95 patients so-defined patients with asthma [age 70 +/- 8 years (mean +/- SD), FE V1 = 0.96 +/- 0.41, 33 male, 75 life-long non-smokers], subjective awa reness, perception and attribution of pulmonary symptoms were poor. Fu rther, despite tangible evidence of reversible and significant airflow limitation, only 21 were receiving inhaled glucocorticoid therapy (me dian daily dose 400 mu g). Asthma in the elderly remains poorly percei ved, poorly recognized and suboptimally treated. These findings are pa rticularly apposite in the light of current epidemiological trends in asthma mortality and morbidity in elderly age cohorts.