Adherence to Asthma Management Guidelines by Middle Aged Adults with Current Asthma

Rangi K Kandane-Rathnayake ^1*, Melanie C Matheson ¹, Julie A Simpson ¹, Mimi L K Tang ², David P Johns ³, Desiree Mesaros ³, Richard Wood-Baker ³, Iain Feather ⁴, Stephen Morrison ⁵, Mark A Jenkins ¹, Graham Giles ⁶, John Hopper ¹, Michael J Abramson ⁷, Shyamali C Dharmage ¹ and E Haydn Walters ³

¹ MEGA Epidemiology Centre, The University of Melbourne, Australia
² Dept Allergy & Immunology, Murdoch Children’s Research Institute, Royal Children’s Hospi, Australia
³ Menzies Research Institute, Tasmania, Australia
⁴ Gold Coast Hospital, Queensland, Australia
⁵ University of Queensland, Queensland, Australia
⁶ Cancer Epidemiology Centre, The Cancer Council of Victoria, Melbourne, Australia
⁷ Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia

^* To whom correspondence should be addressed. E-mail: r.kandane{at}pgrad.unimelb.edu.au.

Accepted 17 July 2009

Abstract

Background: With the increasing burden of asthma world-wide, much effort has been given to developing and updating management guidelines. Using data from the Tasmanian Longitudinal Health Study (TAHS), we investigated the adequacy of asthma management for middle aged adult asthmatics.

Methods: Information about spirometry, medication history and current asthma status was collected by the most recent TAHS when participants were in their mid-forties. Only those who reported ever having asthma were eligible for analysis of this manuscript.

Results: Of the 702 participants who reported ever having asthma, 50% had current asthma (n=351) of whom 71% were categorized as having persistent asthma (n=98 mild, n=92 moderate, n=58 severe). The majority (85.2%) of participants with current asthma had used some form of asthma medication in the past 12 months, but the proportion of the use of minimally adequate preventer medication was low (26%). Post-bronchodilator airflow obstruction increased progressively from mild to severe persistent asthma for those inadequately managed, but not for those on adequate therapy.

Conclusion: Appropriate use of asthma medication by this middle-aged group of adults with current asthma was inadequate, especially for those with adult onset, moderate or severe persistent disease, and without a family history of asthma. Our results suggest that proper use of preventer medication could protect against the progressive decline in lung function associated with increasing severity. This has implications not just for poor quality of life, but also for development of fixed airflow obstruction.