The American Journal of Medicine
Volume 122, Issue 1 , Pages 6-11 , January 2009

Asthma in Seniors: Part 1. Evidence for Underdiagnosis, Undertreatment, and Increasing Morbidity and Mortality

  • Eric Stupka, MD

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Sciences Center at San Antonio, Tex
    • ,
  • Richard deShazo, MD

      Affiliations

    • Division of Clinical Immunology-Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Miss
    • Corresponding Author InformationRequests for reprints should be addressed to Richard deShazo, MD, Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216

References 

  1. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 91-3642). Bethesda, MD: US Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 1991;
  2. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 97-4051). Bethesda, MD: US Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 1997;
  3. Expert Panel Report Update: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 02-5074). Bethesda, MD: US Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2002;
  4. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08-4051). Bethesda, MD: US Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2007;
  5. National Heart, Lung, and Blood Institute. NAEPP Working Group Report: Considerations for Diagnosis and Managing Asthma in the Elderly (NIH Publication No 96-3662). Bethesda, MD: US Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; 1996;
  6. Bauer B, Reed C, Yunginger J, et al. Incidence and outcomes of asthma in the elderly (A population based study in Rochester, Minnesota). Chest. 1997;111:303–310
  7. Moorman J, Rudd R, Johnson C, et al. National surveillance for asthma—United States 1980-2004. MMWR Surveill Summ. 2007;56:1–54
  8. Centers for Disease Control. Interim Projections of the Population by Selected Age Groups for the United States, Regions, and Divisions: April 1, 2000 to July 1, 2030. http://wonder.cdc.gov/WONDER/help/populations/population-projections/SummaryTabC1.pdfAccessed July 11, 2008
  9. Arif A, Delclos G, Lee E, et al. Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III data. Eur Respir J. 2003;21:827–833
  10. Bourgeois F, Porter S, Calim C, et al. The value of patient self-report for disease surveillance. J Am Med Inform Assoc. 2007;14:765–771
  11. Banerjee DK, Lee G, Malik S, Daly S. Underdiagnosis of asthma in the elderly. Br J Dis Chest. 1987;81:23–29
  12. Fried L, Borhani N, Enright P, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1:263–276
  13. Enright P, McClelland R, Newman A, et al. Underdiagnosis and undertreatment of asthma in the elderly. Chest. 1999;116:603–613
  14. Bellia V, Battaglia S, Catalano F, et al. Aging and disability affect misdiagnosis of COPD in elderly asthmatics. Chest. 2003;123:1066–1072
  15. Reed C. The natural history of asthma in adults: the problem of irreversibility. J Allergy Clin Immunol. 1999;103:539–547
  16. Vergnenegre A, Antonini M, Bonnaud F, et al. Comparison between late onset and childhood asthma. Allergol Immunopathol (Madr). 1992;20:190–196
  17. Connolly M, Crowley J, Charan N, et al. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax. 1992;47:410–413
  18. Kronenberg R, Drage C. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest. 1973;52:1812–1819
  19. Brischetto M, Millman R, Peterson D, et al. Effect of aging on ventilatory response to exercise and CO2. J Appl Physiol. 1984;5:1143–1150
  20. Janssens J, Pache J, Nicod L. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999;13:197–205
  21. Campbell D, McLennan G, Coates J, et al. Accuracy of asthma statistics from death certificates in South Australia. Med J Aust. 1992;156:860
  22. Hunt JLW, Silverstein M, Reed C, et al. Accuracy of death certificate in a population-based study of asthmatic patients. JAMA. 1993;269:1947–1952
  23. Guite H, Burney P. Accuracy of recording of deaths from asthma in the UK: the false negtive rate. Thorax. 1996;51:924–928
  24. Moorman J, Mannino D. Increasing US asthma mortality rates: who is really dying?. J Asthma. 2001;38(1):65–71
  25. Bellia V, Pedone C, Catalano F, et al. Asthma in the elderly: mortality rate and associated risk factors for mortality. Chest. 2007;132:1175–1182
  26. Evans RI, Mullally D, Wilson R, et al. National trends in the morbidity and mortality of asthma in the U.S. Prevalence, hospitalization and death from asthma over two decades: 1965-1984. Chest. 1987;91:65S–74S
  27. Settipane G, Greisner W, Settipane R. Natural history of asthma: a 23 year followup of college students. Ann Allergy Asthma Immunol. 2000;84:499–503
  28. Strachan D, Butland B, Anderson H. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. BMJ. 1996;312:1195–1199
  29. Rackemann F, Edwards M. Asthma in children (A follow-up study of 688 patients after an interval of twenty years). N Engl J Med. 1952;246:815–822
  30. Lang P, Parner J, Vestbo J. A 15-year followup study of ventilatry function in adults with asthma. N Engl J Med. 1998;339:1194–1200
  31. Burrows B, Lebowitz M, Barbee R, Cline M. Findings before diagnoses of asthma among the elderly in a longitudinal study of a general population sample. J Allergy Clin Immunol. 1991;88:870–877
  32. Braman S, Kaemmerlen J, Davis S. Asthma in the elderly (A comparison between patients with recently acquired and long-standing disease). Am Rev Respir Dis. 1991;143:336–340
  33. Burrows B, Barbee R, Cline M, et al. Characteristics of asthma among elderly adults in a sample of the general population. Chest. 1991;100:935–942
  34. Huss K, Naumann P, Mason P, et al. Asthma severity, atopic status, allergen exposure, and quality of life in elderly persons. Ann Allergy Asthma Immunol. 2001;86:524–530
  35. Rackemann F, Edwards M. Is intrinsic asthma a reversible disease? A follow-up study. J Allergy. 1958;29:528–534

 Part 2 of this review will appear in the February issue of the Journal.

 Funding: None.

 Conflict of Interest: None.

 Authorship: All authors had equal participation.

PII: S0002-9343(08)00902-9

doi: 10.1016/j.amjmed.2008.09.022

The American Journal of Medicine
Volume 122, Issue 1 , Pages 6-11 , January 2009

Article Tools

* Image Usage & Resolution