Chest
Volume 132, Issue 4, October 2007, Pages 1175-1182
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ORIGINAL RESEARCH
ASTHMA
Asthma in the Elderly: Mortality Rate and Associated Risk Factors for Mortality

https://doi.org/10.1378/chest.06-2824Get rights and content

Background

There is a distinct lack of information on the prognosis of asthma in the elderly.

Methods

In order to compare mortality rates of elderly people with and without asthma and to identify mortality risk factors in those with asthma, 1,233 ambulatory patients aged ≥ 65 years with a diagnosis of asthma (n = 210) or chronic nonrespiratory conditions (n = 1,023) were enrolled in a multicentric study. Patients underwent baseline spirometry and multidimensional assessment and were then followed up for a mean of 57.9 months (SD 16.9). We compared mortality rates in the two groups and identified predictors of death using multivariable survival analysis.

Results

The 5-year mortality rate in people with asthma was 24.3%, compared to 16.3% in control subjects (p < 0.01), but asthma per se did not explain the excess risk of death. The main causes of death among people with and without asthma were cardiovascular diseases (36.4% and 21.3%, respectively), nonneoplastic lung diseases (28.8% vs 5.4%), and neoplasms (7.6% vs 22.6%). In people without asthma, death was associated with age, gender, smoking, cardiovascular diseases, worse performance on a 6-min walking test, cognitive impairment, depression, and worse respiratory function. In people with asthma, only the association between death and age, smoking, and depression was confirmed. At variance with control subjects, in asthmatics we found an inverse correlation between being overweight and death (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.13 to 0.94) and a trend toward a higher mortality rate in people with a body mass index < 22 kg/m2 (HR, 2.21; 95% CI, 0.94 to 5.18).

Conclusions

Asthma in the elderly was associated with higher mortality rate, although this condition was not an independent risk factor. Causes of death and factors associated with death were somewhat different between people with and without asthma.

Section snippets

Materials and Methods

Between January 1996 and July 1999, a total of 1,971 outpatients were recruited from 24 departments of geriatrics or respiratory medicine within the context of the Salute Respiratoria nell'Anziano (Sa.R.A.) [respiratory health in the elderly study]. Details on the Sa.R.A. project are available elsewhere20; the Sa.R.A. study is a multicenter Italian project investigating various aspects of chronic airway diseases in the elderly population (age ≥ 65 years) attending pulmonary or geriatric

Results

People with and without asthma were similar with respect to demographic characteristics. Physical performance was, as expected, slightly worse in the group with asthma, and in this group we also found a higher prevalence of depressed mood. No difference was found, instead, with regard to cognitive performance. Eversmokers were more prevalent in the group with asthma (56.2% vs 47.8%). We found only minimal difference between groups in the prevalence of cerebrovascular disease and diabetes, while

Discussion

This study shows that in elderly asthmatics, death from all causes was increased compared to control subjects. However, asthma per se was not recognized among factors associated with death in pooled asthma and control subjects. Furthermore, the sets of risk factors identified in asthmatics and control subjects substantially differed. Thus, clustering of selected risk factors in asthmatics rather than asthma as a respiratory disease seems relevant to explain the excess mortality rate in

ACKNOWLEDGMENT

The authors are indebted to all the investigators of the Sara Group for their contribution. A list of the investigators may be found at [email protected].

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  • Cited by (0)

    This work was performed at Università degli studi di Palermo-DIMPEFINU, Palermo, Italy.

    The authors have no conflicts of interest to disclose.

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