Perception of bronchoconstriction in elderly asthmatics.
ABSTRACT The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37, group 2, > or = 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, > or = 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 +/- 0.17; group 2, PS20 = 1.37 +/- 0.12, p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (IA, 2.63 +/- 0.30 and IB, 2.07 +/- 0.16, p = 0.101; 2A, 1.36 +/- 0.19 and 2B, 1.59 +/- 0.120, p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and % FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.
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ABSTRACT: Many asthmatic patients fail to perceive their level of disease control. To investigate whether patients' ability to identify asthma control varied with personal characteristics or factors related to disease management. Asthmatic patients were consecutively recruited at 348 pharmacies. They completed a questionnaire (regarding personal characteristics and asthma management) linked to pharmacies records of dispensed medications. The Asthma Control Test questionnaire includes 4 dimensions of asthma control (activity limitations, dyspnea, nocturnal awakenings, and rescue medication use) and assesses patients' perception of control ("How would you rate your asthma control during the past 14 days?"). Analyses were restricted to patients with inadequate control. Patients' perception of control was compared across the other dimensions of the questionnaire. The correlates of patients' failure to perceive inadequate asthma control were investigated. Seven hundred eighteen (68.5%) of the 1,048 patients with inadequate asthma control and documented perception of control considered themselves to be "completely" or "well" controlled. Patients' perception of control did not vary with each dimension of inadequate control. High rates of failure to perceive poor control were observed in patients with at least weekly dyspneas (60%) or nocturnal symptoms (60%). Failure to perceive inadequate control was more likely in patients aged 41 to 50 years (odds ratio, 1.51; 95% confidence interval, 1.05-2.15). No significant effect of factors related to asthma management was observed. Patients with most uncontrolled asthma have difficulty in properly perceiving their level of disease control regardless of their personal characteristics or disease management. The reasons for this poor perception should be investigated. Education programs should be created that focus on knowledge of asthma miscontrol criteria.Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 03/2007; 98(2):146-52. · 3.45 Impact Factor
Article: Der ältere Asthmapatient[Show abstract] [Hide abstract]
ABSTRACT: Ältere Menschen mit Asthma sind eine Patientengruppe mit spezifischen Bedürfnissen, die berücksichtigt werden sollten, um eine erfolgreiche Asthmatherapie zu gewährleisten. Asthma verursacht in dieser Patientengruppe ein vergleichbar höheres Mortalitäts- und Morbiditätsrisiko als bei jüngeren Patienten. Aufgrund altersspezifischer Faktoren haben ältere Asthmatiker häufiger Compliance-Probleme. Zusätzlich ist bei älteren im Vergleich zu jüngeren Asthmapatienten das Risiko erhöht, dass die Erkrankung nicht, verspätet oder fehldiagnostiziert wird. In vielen Fällen resultiert dies aus einer mangelnden Symptomwahrnehmung und -beschreibung des Patienten. Häufig ist die Lebensqualität der Asthmatiker eingeschränkt. Altersgruppenspezifische Maßnahmen zur Verbesserung der Selbstmanagementfähigkeiten können die Situation älterer Asthmatiker positiv beeinflussen. Elderly patients with asthma are a specific group with particular needs. These must be addressed in order to provide appropriate asthma care. Asthma causes higher morbidity and mortality rates among the elderly patients. Older patients often fail or have problems with compliance and self-management due to age-specific factors. Older patients with asthma are often misdiagnosed, due to an impaired patient perception of symptom severity, different opinions of what kind of asthma-control is possible, or not sufficient communication skills. Often the quality of life is impaired by asthma. Improvement in self management skills in a special way may enhance the health status of elderly patients with asthma.Der Internist 01/2008; 49(11):1335-1342. · 0.33 Impact Factor
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ABSTRACT: A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics.Clinical Interventions in Aging 01/2013; 8:913-22. · 2.65 Impact Factor