Older Patient Asthma Symptom Management Associated with Direct Involvement

Keerthi R. Karamched, MD

A higher quality of life for older patients with asthma is associated with them being more involved in medical decisions and symptoms management, according to a recent study.

There are currently 2 million Americans over the age of 65 who have asthma, according to the US Department of Health and Human Services Administration on Aging. While most people experience their first asthma symptoms at a young age, a proportion of the patient population first receives their diagnosis while in their 70s, or even 80s.

Asthma also gives rise to additional health risks for older adults, leaving them more vulnerable to respiratory failure. The Asthma and Allergy Foundation of America notes that older asthma patients with only mild symptoms can have the same level of breathing difficulty as a younger patient having a severe asthma attack.

Recent studies have also shown that shared decision-making between the patient and physician not only improves patient experience and quality of care, but also may even be cost-effective.

For this most recent study, researchers used data from an ongoing randomized clinical trial of asthma self-management for adults utilizing standard asthma education, complementary techniques, and enhanced patient-physician communication during a 12-month period.

Participants were 55 years of age or older with physician-diagnosed persistent asthma. Researchers excluded patients with chronic obstructive pulmonary disease (COPD) or other pulmonary disease, current tobacco use, and/or a history of smoking more than 20 packs of cigarettes annually—a habit commonly associated with an increased risk of COPD. The final count was 189 patients.

Lung function was assessed using pre-bronchodilator and post-bronchodilator spirometric values. Asthma control and quality of life was measured using the Asthma Control Test (ACT) score and Mini-Asthma Quality of Life Questionnaire (AQLQ), respectively. Depression was calculated using the Geriatric Depression Scale.

Asthma exacerbations were evaluated using the number of corticosteroid uses, hospitalizations, emergency department visits, and unscheduled or urgent care physicians visits during the previous 12 months. Patient preferences for autonomy in asthma management were gauged using the Autonomy Preference Index (API), a measurement that has only been used in the younger asthma population.

Findings show that higher autonomy levels were associated with women (P= 0.007), higher education level (P= 0.01), and lower levels of depression (P= 0.04). There was also a positive correlation between a higher degree of autonomy in adults and a higher Mini-AQLQ (P= 0.01).

“In younger populations that have asthma, autonomy preferences were not found to impact any outcomes in prior studies,” study author Keerthi R. Karamched, MD, allergist/immunologist at University of Michigan, Ann Arbor, told MD Magazine®. “But in the older adult asthmatic population, these results indicate we should consider utilizing the Autonomy Preference Index to better understand patient autonomy when managing their asthma.”

But because this study was a cross sectional analysis, only a correlation was found. Karamched said that the job of future studies would be to help identify causation, if any, between autonomy and quality of life.

The study, “The impact of patient autonomy on older adults with asthma," was published online in Annals of Allergy, Asthma and Immunology.