Underdiagnosis and undertreatment of asthma in the elderly

Objective: To describe the clinical correlates of asthma in a community-bas ed sample of elderly persons, Participants: A community sample of 4,581 persons greater than or equal to 65 years old from the Cardiovascular Health Study. Measurements: Standardized respiratory, sleep, and quality-of-life (QOL) qu estions, a medication inventory, spirometry, and ambulatory peak flow. Results: Four percent of the participants reported a current diagnosis of a sthma (definite asthma), while another 4% reported at least one attack of w heezing accompanied by chest tightness or dyspnea during the previous 12 mo nths (probable asthma), Smokers and those with congestive heart failure wer e excluded from the subsequent analyses, leaving 2,527 participants. Of tho se who had definite asthma, 40% were taking a sympathomimetic bronchodilato r, 30% inhaled corticosteroids, 21% theophylline, and 18% oral corticostero ids; 39% were taking no asthma medications. The participants with definite or probable asthma were much more likely than the others to have a family h istory of asthma, childhood respiratory problems, a history of workplace ex posures, dyspnea on exertion, hay fever, chronic bronchitis, nocturnal symp toms, and daytime sleepiness. They were also more likely to report poor gen eral health, symptoms of depression, and limitation of activities of daily living. There was little difference in the morbidity and QOL of participant s 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 c onsiderable morbidity when compared with those who do not have asthma sympt oms. Asthma is underdiagnosed in this group and is often associated with al lergic triggers; inhaled corticosteroids are underutilized.