Barr RG, Somers SC, Speizer FE, Camargo CA Jr. Arch Intern Med. 2002;162:1761–1768
Purpose of the Study.
Asthma guidelines are well-established but often followed poorly. Determinants of adherence among older persons may differ from younger persons and have not been well-characterized. The purpose of this study was to assess adherence to asthma medication guidelines among older women with asthma and evaluate predictors of adherence with emphasis on asthma characteristics, comorbid medical conditions, work-related factors, social supports, caregiving, and emotional well-being.
Study Population and Methods.
The authors assessed adherence to the National Asthma Education and Prevention Program medication guidelines among participants in the Nurses’ Health Study who reported a physician diagnosis of asthma and reconfirmed the diagnosis on a separate questionnaire, excluding those with chronic obstructive pulmonary disease.
Among 121 700 participants in the Nurses’ Health Study, 5107 reported physician-diagnosed asthma meeting inclusion criteria. Mean ± standard deviation (SD) age was 63 ± 7 years in 1998. Adherence with asthma medication guidelines was 57% for mild persistent, 55% for moderate persistent, and 32% for severe persistent asthma (P = .001). In multivariate analysis, nonadherence was associated with severe asthma, increasing age, lower socioeconomic status, current smoking, earlier onset of asthma, and number of comorbid medical conditions. Measures of social isolation, caregiving, and emotional well-being were not associated with nonadherence.
Asthma is undertreated among older women, even those who are health care professionals. Women with advanced age and severe asthma were particularly at risk. Given that the greatest increase in asthma mortality has occurred among older women, additional research is needed to examine physician prescribing patterns and patient beliefs in this vulnerable population.
Unfortunately, severe asthma is often a result of nonadherence. Nonetheless, it’s helpful to identify the “profile” of patients most in need of our attention and interventions.