Prevalence of untreated asthma in a population sample of 6000 older adults in Bristol, UK
- aCare of the Elderly, Division of Medicine, University of Bristol, Bristol, UK, bNHS R&D Support Unit, North Bristol NHS Trust, Bristol, UK, cMRC Environmental Epidemiology Unit, Community Clinical Sciences, University of Southampton, Southampton, UK, dUniversity Medicine, University of Southampton, eGeneral Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK
- Dr L Dow, Care of the Elderly, Frenchay Hospital, Bristol BS16 1LE, UK
- Received 20 July 2000
- Revision requested 6 November 2000
- Revised 26 January 2001
- Accepted 26 February 2001
BACKGROUND A study was undertaken to estimate the prevalence of untreated asthma in older adults.
METHODS A cross sectional population based survey of 6000 men and women aged 65 years and over was performed in 21 general practices in north Bristol, south west England. The main outcome measure was untreated asthma as defined by a two stage process comprising a respiratory questionnaire (symptoms suggestive of asthma or doctor diagnosed asthma not receiving respiratory treatment) followed by lung function tests (significant reversibility following bronchodilators or corticosteroids and/or significant within day variability in peak expiratory flow).
RESULTS 4792 of the 6000 participants (80%) completed the respiratory questionnaire and, of those not receiving respiratory treatment, 55 reported a previous doctor diagnosis of asthma and a further 696 had symptoms suggestive of asthma. Lung function testing in 280 of 501 randomly selected individuals from these groups resulted in 38 being defined as having asthma and an estimated population prevalence for untreated asthma of 2.4% (95% CI 1.6% to 3.6%) in men and 1.2% (95% CI 0.7% to 2.1%) in women. Most subjects (84%) with untreated asthma had moderate or severe disease. Untreated asthma was most common in individuals with doctor diagnosed asthma (21%) and those with breathlessness or wheeze (13–20%).
CONCLUSION Untreated asthma in the elderly is a common and important problem. Opportunistic use of appropriate lung function tests in older people with a history of doctor diagnosed asthma or wheeze or breathlessness at rest could identify untreated asthmatics who might benefit from treatment.
Funding: The Wellcome Trust provided the grant for this study and GlaxoWellcome provided the drugs and volume spacer devices used in reversibility testing.
Conflicts of interest: LD, LF, LP have received educational grants from 3M, MSD, Boehringer Ingelheim, and GlaxoWellcome supporting travel, accommodation, and lecture fees for respiratory meetings and sponsorship of educational courses. STH has received grants to support primary and applied research into asthma and COPD from Astra Zeneca, Schering Plough, Novartis, SKB, MSD, GlaxoWellcome, and Yamanouchi.