Introduction

Asthma is a major cause of morbidity and a high user of health service resources. Correct diagnosis and treatment regime is essential for reducing social and economic costs for both patients and the health service.

Aim

To determine whether alternative management options should be considered when treating elderly asthmatics.

Method

Two studies which involved the audit of asthma management within a general practice setting. 393 practices from throughout the United Kingdom provided details of health service resource use for 30 randomly selected asthma patients over a retrospective 12 month period. This provided a data set on the management of 12,203 patients with asthma. All patients were invited for a clinical assessment. Under 5’s were discounted from further analysis due to unique problems and management costs. The remaining 11,606 were stratified into two age groups, 10,016(82%) were aged from 5 to 64 years and 1,590(13%) 65 or over. Comparisons were made for management and outcome measures between these two groups.

Results

Healthcare contact & attack rate	Age Group (years)
n=11,606	5-64 n=10,016 (84%)	65+ n=1,590 (14%)
Asthma attack	2044(20%)	388 (24%)
Admission	237 (2%)	65 (4%)
A&E contact	275 (3%)	28 (2%)
OPD contact	511 (5%)	137 (9%)
Urgent Consultation	5718(57%)	948 (60%)
Review Consultation	6614(66%)	1113(70%)

Patients who attended for Study Review
	Age Group (years)
Symptom/Risk Factor n=9156	5-64 n=7771 (78%)	65+ n=1385 (87%)
Night symptoms	2639(34%)	497(36%)
Morning symptoms	3142(40%)	788(57%)
Exercise symptoms	4319(56%)	1046(76%)
Poor Compliance	1247(16%)	165(12%)
Poor Inhaler Tech.	589(8%)	154(11%)

Patients 65 plus experienced more morning and exercise symptoms (p<0.001) and had more admissions to hospital (p<0.001). They received higher levels of medication (p<0.001) and were more compliant (p<0.001), but had poorer inhaler technique upon assessment (p<0.001).

Conclusion

Despite higher medication levels 1,164(73%) patients over 64 years in age reported symptoms, 430(37%) on a daily basis. For older patients, where regular symptoms are present despite high levels of medication, investigation for chronic obstructive pulmonary disease should be considered. This would ensure that treatment with regular bronchodilators is offered at the earliest possible stage. The high doses of inhaled steroids which many of these patients are receiving may be inappropriate. With the average annual cost of managing an asthmatic patient in this group being £376.73, a more suitable medication regime would make better use of health service resources.