Asthma in the elderly: underperceived, underdiagnosed and undertreated; a community survey
Asthma in the elderly: underperceived, underdiagnosed and undertreated; a community survey
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DOI：
10.1016/s0954-6111(98)90311-0
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发表时间：
1998-03-01
影响因子：
4.3
通讯作者：
Bansal, SK
中科院分区：
文献类型：
--
作者：
Parameswaran, K;Hildreth, AJ;Bansal, SK
现在越来越多的老年人认识到支气管哮喘，并与显著的发病率和死亡率有关。这项研究的目的有两个：第一，评估社区老年患者中哮喘的患病率，第二，评估老年患者对哮喘的诊断意识、治疗管理和患者感知。从英格兰东北部城市全科医生的年龄-性别登记中，2004年65岁的患者符合纳入条件。对呼吸道症状的初始筛查问卷的应答率为68%(n=1362)。在这些患者中，869名患者有呼吸道症状：390名自愿同意接受进一步评估，包括呼吸道生理评估。在这组患者中，369/390人进行了阻塞性肺活量测定，其中95人符合哮喘的临床和生理标准。这个年龄段的哮喘患病率最低，相当粗略地分配为4.5%(95/2004)。在95名如此定义的哮喘患者中[年龄70+/-8岁(平均+/-SD)，FEV1=0.96+/-0.41，33名男性，75名终生非吸烟者]，对肺部症状的主观意识、感知和归因能力较差。此外，尽管有明显的可逆和显著的气流受限的证据，但只有21人正在接受吸入糖皮质激素治疗(中位数每天400微克)。老年哮喘患者仍然缺乏感知、认识和次优治疗。鉴于目前在老年人群中哮喘、死亡率和发病率方面的流行趋势，这些研究结果特别恰当。
Bronchial asthma is now increasingly recognized in the elderly and is associated with significant morbidity and mortality. The aims of this study were two-fold: first, to assess the prevalence and, second, to evaluate diagnostic awareness, therapeutic management and patient perception of bronchial asthma among elderly patients in the community.From the age-sex register of an urban general practice in NE England, 2004 patients aged >65 years were eligible for inclusion. Response to an initial screening questionnaire on respiratory symptomatology was 68% (n = 1362). Of these, 869 patients had respiratory symptoms: 390 voluntarily agreed to be evaluated further including assessment of airway physiology. In this group 369/390 had obstructive spirometry and, of these, 95 patients fulfilled clinical and physiological criteria of bronchial asthma. Prevalence of asthma within this age cohort was minimally and rather crudely assigned at 4.5% (95/2004).Among the 95 patients so-defined patients with asthma [age 70 +/- 8 years (mean +/- SD), FEV1 = 0.96 +/- 0.41, 33 male, 75 life-long non-smokers], subjective awareness, perception and attribution of pulmonary symptoms were poor. Further, despite tangible evidence of reversible and significant airflow limitation, only 21 were receiving inhaled glucocorticoid therapy (median daily dose 400 mu g).Asthma in the elderly remains poorly perceived, poorly recognized and suboptimally treated. These findings are particularly apposite in the light of current epidemiological trends in asthma mortality and morbidity in elderly age cohorts.