Asthma in the older adult.

Objective: The older adult population is increasing worldwide, and a significant percentage has asthma. This review will discuss the challenges to diagnosis and management of asthma in older adults. Data Sources: PubMed was searched for multiple terms in various combinations, including asthma, older adult, elderly, comorbid conditions, asthma diagnosis, asthma treatment, biologics and medication side effects, and adverse events. From the search, the data sources that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Study Selections: Study selections that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Results: Asthma in older adults is frequently underdiagnosed and has higher morbidity and mortality rates compared to their younger counterparts. A detailed history and physical examination as well as judicious testing are essential to establish the asthma diagnosis and exclude alternative ones. Medical comorbidities, such as cardiovascular disease, cognitive impairment, depression, arthritis, gastroesophageal reflux disease (GERD), rhinitis, and sinusitis are common in this population and should also be assessed and treated. Non-pharmacologic management, including asthma education on inhaler technique and self-monitoring, is vital. Pharmacologic management includes standard asthma therapies such as inhaled corticosteroids (ICS), inhaled corticosteroid-long acting ß-agonist combinations (ICS-LABA), leukotriene antagonists, long acting muscarinic antagonists (LAMA), and short acting bronchodilators (SABA). Newly approved biologic agents may also be utilized. Older adults are more vulnerable to polypharmacy and medication adverse events, and this should be taken into account when selecting the appropriate asthma treatment. Conclusions: The diagnosis and management of asthma in older adults has certain challenges, but if the clinician is aware of them, the morbidity and mortality of this condition can be improved in this growing population.

Understanding the relationship among pharmacoadherence measures, asthma control test scores, and office-based spirometry.

BACKGROUND: This study used accepted asthma metrics and pharmaceutical claim data to develop a new asthma metric as a possible surrogate for spirometry and to better assess asthma control. OBJECTIVE: To develop and validate a new asthma metric called the Rescue Index (RI) based on ß(2)-agonist dispensings and to test the feasibility of a multivariate model to construct a global asthma metric called the Asthma Control Index (ACI). METHODS: This prospective, observational, multicenter cohort study was conducted at the Naval Medical Center San Diego (NMCSD) and at the Phoenix VA Health Care System (PVAHCS). Pharmacy claim data were correlated with the ACT, Medication Adherence Report Scale for Asthma (MARS-A), and spirometry using univariate and multivariate analyses. RESULTS: A total of 263 individuals enrolled in the study, and 95 (PVAHCS) and 156 (NMCSD) individuals completed the study. In the PVAHCS, the ACT correlated with the asthma medication ratio (AMR) (ρ = 0.37, P < .001) and inversely correlated with the RI (ρ = -0.33, P = .001), the RI inversely correlated with forced expiratory volume in 1 second (FEV(1)) (ρ = -0.22, P = .03) and the FEV(1) to forced vital capacity ratio (ρ = 0.22, P = .03). In the NMCSD population, the ACT correlated with the MARS-A (ρ = 0.23, P = .006), FEV(1) did not correlate with ACT (ρ = 0.09, P = .25) or MARS-A (ρ = 0.16, P = .047) but directly correlated with the RI (ρ = 0.19, P = .03). The AMR was strongly inversely correlated with RI in both populations (-0.74, P < .001 in the PVAHCS group and -0.78, P < .001 in the NMCSD group). When multivariate models were applied to the NMCSD and PVAHCS groups, the combination of RI and MARS-A was the best predictor of spirometry. CONCLUSION: The RI shows promise as a new asthma metric because it correlated with AMR in both cohorts. However, because RI correlated with adult spirometry and ACT only, further validation studies are needed before RI may be included in an ACI metric.