Chest
Volume 100, Issue 4, October 1991, Pages 935-942
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Characteristics of Asthma among Elderly Adults in a Sample of the General Population

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This article describes the characteristics and course of asthma among subjects who were older than 65 years at the time of enrollment in a longitudinal study of a general population sample. It was present in 3.8 percent of men and 7.1 percent of women. An additional 4.1 percent of men reported having “asthma,” but they also had seen a physician for “emphysema” and had smoked significantly; their “asthma” diagnosis is regarded as highly questionable. They did not show the elevated rate of allergy skin test reactivity of high serum IgE levels that were characteristic of other asthmatics. Many of the elderly asthmatics (mean age, 72 years) had severe disease with marked ventilatory impairment. There was a close relationship between the severity of wheezing complaints and impairment of the FEV1. Of the 46 patients, 48 percent reported an onset before age 40 years. There was no relationship between severity and age of onset or duration of disease. A second diagnosis of “chronic bronchitis” was reported by 46 percent of the asthmatics, but this did not delineate a distinctive group with late-onset, smoking-related disease. Death rates in the asthmatics tended to be higher than in nonasthmatics (odds ratio, 1.9; CI, 0.998 to 3.70, after stratifying by sex). Over a mean follow-up of 7.44 years, most symptoms as well as the FEV1 remained relatively stable. Chronic productive cough did tend to remit (p<0.01), but this was noted in the nonasthmatics as well. We estimate that no more than 19 percent of the asthmatics went into complete remission during follow-up. Most of these had mild initial symptoms; there were no remissions in subjects with severe disease at the time of entry. We concluded that asthma in the elderly is not a rare disease and may be associated with severe symptoms and chronic airways obstruction. If severe, it rarely goes into complete remission but tends to remain a severe, disabling disorder.

Section snippets

METHODS

The subjects are part of a longitudinal study of a stratified random cluster sample of white, non-Mexican-American households in Tucson, AZ, in 1971 to 1972. Details of selection of the population sample have been published.4 New members of these households have continued to be enrolled throughout the follow-up period. Some of the new enrollees were new spouses as well as some parents who moved in with their children. Through the eighth survey of this population, completed in 1984, a total of

Asthma and IgE:

As noted under the “Methods” section, the mean IgE of asthmatics is significantly elevated. Even in these elderly subjects, a minority of whom are STpos, there is a very close relationship between the prevalence of asthma and age- and sex-standardized serum IgE level, as shown in Figure 1.

Smoking and Asthma

The smoking histories of our asthmatic subjects and the relationship of their smoking habits to some other characteristics are summarized and compared with findings in nonasthmatics in Table 2. Even after

DISCUSSION

Active asthma appears to be a relatively common problem in subjects older than 65 years who are part of a population sample being followed up longitudinally in Tucson. Since our population could well be biased by selective in-migration to southern Arizona of patients with this type of disorder, we decided to send a brief questionnaire to 25 pulmonary physicians in other parts of the United States to determine whether they are seeing similar types of patients. It was completed by 23 of the 25

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Supported by a Specialized Center of Research Grant (HL 14136) from the National Heart, Lung, and Blood Institute

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