Skip to main content
Thorax logoLink to Thorax
. 2001 Jun;56(6):472–476. doi: 10.1136/thorax.56.6.472

Prevalence of untreated asthma in a population sample of 6000 older adults in Bristol, UK

L Dow 1, L Fowler 1, L Phelps 1, K Waters 1, D Coggon 1, A Kinmonth 1, S Holgate 1
PMCID: PMC1746072  PMID: 11359964

Abstract

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.



Full Text

The Full Text of this article is available as a PDF (115.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen S. C., Prior A. What determines whether an elderly patient can use a metered dose inhaler correctly? Br J Dis Chest. 1986 Jan;80(1):45–49. doi: 10.1016/0007-0971(86)90008-2. [DOI] [PubMed] [Google Scholar]
  2. Barnes P. J., Jonsson B., Klim J. B. The costs of asthma. Eur Respir J. 1996 Apr;9(4):636–642. doi: 10.1183/09031936.96.09040636. [DOI] [PubMed] [Google Scholar]
  3. Britton J., Hanley S. P., Garrett H. V., Hadfield J. W., Tattersfield A. E. Dose related effects of salbutamol and ipratropium bromide on airway calibre and reactivity in subjects with asthma. Thorax. 1988 Apr;43(4):300–305. doi: 10.1136/thx.43.4.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burney P. G., Laitinen L. A., Perdrizet S., Huckauf H., Tattersfield A. E., Chinn S., Poisson N., Heeren A., Britton J. R., Jones T. Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. Eur Respir J. 1989 Nov;2(10):940–945. [PubMed] [Google Scholar]
  5. Burrows B., Barbee R. A., Cline M. G., Knudson R. J., Lebowitz M. D. Characteristics of asthma among elderly adults in a sample of the general population. Chest. 1991 Oct;100(4):935–942. doi: 10.1378/chest.100.4.935. [DOI] [PubMed] [Google Scholar]
  6. Dales R. E., Spitzer W. O., Tousignant P., Schechter M., Suissa S. Clinical interpretation of airway response to a bronchodilator. Epidemiologic considerations. Am Rev Respir Dis. 1988 Aug;138(2):317–320. doi: 10.1164/ajrccm/138.2.317. [DOI] [PubMed] [Google Scholar]
  7. Dickinson J. A., Meaker M., Searle M., Ratcliffe G. Screening older patients for obstructive airways disease in a semi-rural practice. Thorax. 1999 Jun;54(6):501–505. doi: 10.1136/thx.54.6.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dodge R., Cline M. G., Burrows B. Comparisons of asthma, emphysema, and chronic bronchitis diagnoses in a general population sample. Am Rev Respir Dis. 1986 Jun;133(6):981–986. doi: 10.1164/arrd.1986.133.6.981. [DOI] [PubMed] [Google Scholar]
  9. Dow L., Coggon D., Holgate S. T. Respiratory symptoms as predictors of airways lability in an elderly population. Respir Med. 1992 Jan;86(1):27–32. doi: 10.1016/s0954-6111(06)80144-7. [DOI] [PubMed] [Google Scholar]
  10. Dow L., Coggon D., Osmond C., Holgate S. T. A population survey of respiratory symptoms in the elderly. Eur Respir J. 1991 Mar;4(3):267–272. [PubMed] [Google Scholar]
  11. Enright P. L., Kronmal R. A., Higgins M., Schenker M., Haponik E. F. Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. Am Rev Respir Dis. 1993 Jan;147(1):125–133. doi: 10.1164/ajrccm/147.1.125. [DOI] [PubMed] [Google Scholar]
  12. Gannon P. F., Newton D. T., Pantin C. F., Burge P. S. Effect of the number of peak expiratory flow readings per day on the estimation of diurnal variation. Thorax. 1998 Sep;53(9):790–792. doi: 10.1136/thx.53.9.790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Quanjer P. H., Tammeling G. J., Cotes J. E., Pedersen O. F., Peslin R., Yernault J. C. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:5–40. [PubMed] [Google Scholar]
  14. Siersted H. C., Boldsen J., Hansen H. S., Mostgaard G., Hyldebrandt N. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ. 1998 Feb 28;316(7132):651–656. [PMC free article] [PubMed] [Google Scholar]
  15. Spector S. L., Smith L. J., Glass M. Effects of 6 weeks of therapy with oral doses of ICI 204,219, a leukotriene D4 receptor antagonist, in subjects with bronchial asthma. ACCOLATE Asthma Trialists Group. Am J Respir Crit Care Med. 1994 Sep;150(3):618–623. doi: 10.1164/ajrccm.150.3.8087328. [DOI] [PubMed] [Google Scholar]
  16. Thiadens H. A., de Bock G. H., Dekker F. W., Huysman J. A., van Houwelingen J. C., Springer M. P., Postma D. S. Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study. BMJ. 1998 Apr 25;316(7140):1286–1290. doi: 10.1136/bmj.316.7140.1286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Tinkelman D. G., Avner S. E., Cooper D. M. Assessing bronchodilator responsiveness. J Allergy Clin Immunol. 1977 Feb;59(2):109–114. doi: 10.1016/0091-6749(77)90211-1. [DOI] [PubMed] [Google Scholar]
  18. de Marco R., Cerveri I., Bugiani M., Ferrari M., Verlato G. An undetected burden of asthma in Italy: the relationship between clinical and epidemiological diagnosis of asthma. Eur Respir J. 1998 Mar;11(3):599–605. [PubMed] [Google Scholar]
  19. van den Boom G., van Schayck C. P., van Möllen M. P., Tirimanna P. R., den Otter J. J., van Grunsven P. M., Buitendijk M. J., van Herwaarden C. L., van Weel C. Active detection of chronic obstructive pulmonary disease and asthma in the general population. Results and economic consequences of the DIMCA program. Am J Respir Crit Care Med. 1998 Dec;158(6):1730–1738. doi: 10.1164/ajrccm.158.6.9709003. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES