Is Asthma Control Really More Difficult to Achieve in the Elderly Patient?

Boulet, Louis‐Philippe

doi:10.1159/000368966

Cited by 7 publications

(10 citation statements)

References 17 publications

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“…Similar to the previous literature [13], age was a significant predictor of in-hospital mortality in asthma patients in our study. A higher burden of underlying comorbidities in elderly patients could likely contribute to higher in-hospital mortality.…”

Section: Discussionsupporting

confidence: 92%

Asthma: Hospitalization Trends and Predictors of In-Hospital Mortality and Hospitalization Costs in the USA (2001-2010)

Kaur

Lahewala

Arora

et al. 2015

Int Arch Allergy Immunol

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Background: In the last decade, the proportion of people with asthma in the USA grew by nearly 15%, with 479,300 hospitalizations and 1.9 million emergency department visits in 2009 alone. The primary objective of our study was to evaluate in-hospital outcomes in patients admitted with asthma exacerbation in terms of mortality, length of stay (LOS) and hospitalization costs. Methods: We queried the HCUP's Nationwide Inpatient Sample (NIS) between 2001 and 2010 using the ICD9-CM diagnosis code 493 for asthma (n = 760,418 patients). The NIS represents 20% of all hospitals in the USA. Multivariate logistic regression analysis was used to evaluate predictors of in-hospital mortality. LOS and hospitalization costs were also analyzed. Results: The overall LOS was 3.9 days and as high as 8.3 days in patients requiring mechanical ventilation. LOS has decreased in recent years, though it continues to be higher than in 2001. The hospitalization cost increased steadily over the study period. The overall in-hospital mortality was 1% and as high as 9.8% in patients requiring mechanical ventilation. Multivariate predictors of longer LOS, higher hospitalization costs and in-hospital mortality included increasing age and hospitalizations during the winter months. Private insurance was predictive of lower hospitalization costs and LOS as well as lower in-hospital mortality. Conclusion: Asthma continues to account for significant in-hospital mortality and resource utilization, especially in mechanically ventilated patients. Age, admissions during winter months and the type of insurance are independent predictors of in-hospital outcomes.

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Section: Discussionsupporting

confidence: 92%

Asthma: Hospitalization Trends and Predictors of In-Hospital Mortality and Hospitalization Costs in the USA (2001-2010)

Kaur

Lahewala

Arora

et al. 2015

Int Arch Allergy Immunol

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“…With the regard to age, Bellia et al followed up 1233 ambulatory patients aged > 65 years with a diagnosis of asthma or chronic non respiratory conditions and showed that asthma in the elderly was associated with higher mortality rate, although this condition was not an independent risk factor [ 16 ]. Differently, age was a significant predictor of in-hospital mortality in asthma patients, however a higher burden of underlying comorbidities in elderly patients could likely contribute to higher in-hospital mortality [ 13 , 18 ]. Asthma hospitalization during the winter months was also significantly predictive of increased in-hospital mortality, probably because winter months were associated with a concurrently higher prevalence of respiratory viral infections, including influenza [ 13 ].…”

Section: Main Bodymentioning

confidence: 99%

“…The NRAD identified 195 cases of asthma deaths in the United Kingdom during 2012–2013 [ 20 ]. Key findings from the report include that nearly half died without seeking medical assistance or before emergency medical care could be provided, and the majority were not under specialist medical supervision during the year prior to death [ 18 , 19 ]. Only one-quarter had been provided with a personal asthma action plan, acknowledged to improve asthma care, and there was evidence of excessive prescribing of short-acting reliever medication, under-prescribing of preventer medication, and inappropriate prescribing of long-acting beta-agonist bronchodilator inhalers as the sole form of treatment.…”

Section: Main Bodymentioning

confidence: 99%

Asthma-related deaths

D’Amato

Vitale

Molino

et al. 2016

Multidiscip Respir Med

109

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Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide

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“…Although asthma patients of older age and those with asthma in pregnancy are considered, there is a major lack of information, representing an urgent research need to close the gaps [18,19]. Interestingly, some insufficiently evidenced recommendations are proposed for asthma in older patients and the use of cardiac drugs.…”

Section: @Erspublicationsmentioning

confidence: 99%