Diette Gregory B, Krishnan Jerry A, Dominici Francesca, Haponik Ed, Skinner Elizabeth Ann, Steinwachs Donald, Wu Albert W
Department of Medicine, School of Medicine, Johns Hopkins University, Room 301, 1830 E Monument St, Baltimore, MD 21205, USA.
Arch Intern Med. 2002 May 27;162(10):1123-32. doi: 10.1001/archinte.162.10.1123.
Although older adults (> or =65 years) with asthma have higher rates of hospitalization and death from asthma than younger adults, the reasons for this are not known.
To determine whether patterns of care were less favorable for older than younger adults with asthma and to assess whether patient characteristics such as symptom severity and comorbid illnesses explain the higher rate of hospitalization.
Prospective cohort study of 6590 adults with asthma in 15 managed care organizations in the United States. Participants completed a survey of demographics, symptoms, health status, comorbid illnesses, treatment, access to care, self-care knowledge, physician specialty, and health care use.
Among 6590 adults with asthma, 554 (8%) were 65 years or older and 1942 (29%) were aged 18 to 34 years. Older patients were more likely than younger patients to be men, white, non-Hispanic, and less educated. At baseline, older patients reported a greater frequency of asthma-related symptoms, such as daily cough (36% vs 22%, P<.001) and wheezing (27% vs 22%, P<.002). They were also more likely to report comorbid conditions, such as sinusitis (50% vs 38%), heartburn (35% vs 23%), chronic bronchitis (43% vs 16%), emphysema (19% vs 1%), congestive heart failure (8% vs 1%), and history of smoking (54% vs 34%) (all P<.001). Care appeared to be better for the older patients compared with the younger, including more frequent use of inhaled corticosteroids, greater self-management knowledge, and fewer reported barriers to care. In the follow-up year, older patients were approximately twice as likely to be hospitalized (14%) than were younger patients (7%) (P<.001). In multivariate analysis, however, older age was not predictive of future hospitalization (odds ratio, 1.05; 95% confidence interval, 0.68-1.61), after adjustment for sex, ethnicity, education, baseline asthma symptoms, health status, comorbid illnesses, and tobacco use. Factors independently associated with hospitalization included being female, nonwhite, less educated, and less physically healthy, and more frequent asthma symptoms.
Although the older adults with asthma had greater respiratory symptoms and more comorbidity than their younger counterparts, chronologic age was not an independent risk for hospitalization. Appropriate care for older adults with asthma should address asthma symptoms and other chronic conditions.
尽管老年哮喘患者（≥65岁）因哮喘住院和死亡的比率高于年轻患者，但其原因尚不清楚。
确定老年哮喘患者的治疗模式是否不如年轻患者，以及评估症状严重程度和合并症等患者特征是否能解释较高的住院率。
对美国15个管理式医疗组织中的6590例成年哮喘患者进行前瞻性队列研究。参与者完成了一项关于人口统计学、症状、健康状况、合并症、治疗、就医途径、自我护理知识、医生专业和医疗保健使用情况的调查。
在6590例成年哮喘患者中，554例（8%）年龄在65岁及以上，1942例（29%）年龄在18至34岁之间。老年患者比年轻患者更可能为男性、白人、非西班牙裔且受教育程度较低。在基线时，老年患者报告的哮喘相关症状频率更高，如每日咳嗽（36%对22%，P<0.001）和喘息（27%对22%，P<0.002）。他们也更可能报告合并症，如鼻窦炎（50%对38%）、胃灼热（35%对23%）、慢性支气管炎（43%对16%）、肺气肿（19%对1%）、充血性心力衰竭（8%对1%）和吸烟史（54%对34%）（所有P<0.001）。与年轻患者相比，老年患者的治疗似乎更好，包括更频繁使用吸入性糖皮质激素、更多的自我管理知识以及更少的就医障碍报告。在随访的一年中，老年患者住院的可能性约为年轻患者的两倍（14%对7%）（P<0.001）。然而，在多变量分析中，在调整了性别、种族、教育程度、基线哮喘症状、健康状况、合并症和吸烟情况后，年龄较大并不能预测未来的住院情况（优势比，1.05；95%置信区间，0.68 - 1.61）。与住院独立相关的因素包括女性、非白人、受教育程度较低、身体健康状况较差以及更频繁的哮喘症状。
尽管老年哮喘患者比年轻患者有更严重的呼吸道症状和更多的合并症，但年龄并不是住院的独立危险因素。对老年哮喘患者的适当治疗应针对哮喘症状和其他慢性疾病。
