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Main contributory factors on asthma control and health-related quality of life (QoL) in elderly asthmatics

Enríquez-Matas A*,1, Fernández Rodríguez C*,1, Andrés Esteban EM2, Fernández Crespo J1

1Servicio de Alergología, Hospital Universitario 12 de Octubre, Instituto de Investigación, Hospital 12 de Octubre (i+12) , Madrid
2Instituto de Investigación Sanitaria, Unidad de investigación clínica, Hospital Universitario 12 de Octubre, Madrid
*Both authors contributed equally to this work

J Investig Allergol Clin Immunol 2020; Vol. 30(4)
doi: 10.18176/jiaci.0430

Objective: To assess the main contributory factors on asthma control and on health-related quality of life in elderly asthmatic subjects.
Methods: Retrospective case-control study nested in historical cohort that compared patients who had partly or uncontrolled asthma (ACT ≤ 19) (cases) with patients who had well asthma control (ACT ≥ 20) (controls). Data regarding clinical characteristics were collected from medical records. Outcomes included ACT (asthma control test), and health-related quality of life (AQLQ) (asthma-specific quality of life questionnaire). Pulmonary function was determined by spirometry.
Results: We evaluated 209 patients (151 women) ≥ 65 years old with asthma. Mean age was 73.55 years. Most patients had persistent moderate (47.60%) or severe (47.12%) asthma. A total ACT score ≤ 19 was obtained in 64 (30.62%) patients. Lack of adherence to treatment and presence of severe exacerbations behaved as a risk factor for partly controlled/uncontrolled asthma (OR 8.33 and OR 5.29, respectively). In addition, for each unit scored more in the AQLQ, the risk of poor control increased 1.51. Factors influencing AQLQ were asthma control (ACT) and presence of comorbidities such as depression, GERD and osteoporosis.
Conclusions: Despite receiving anti-asthmatic therapy, almost one-third of elderly patients had uncontrolled asthma. Factors related to treatment adherence, exacerbations and health-related quality of life should be considered. Non-respiratory comorbid conditions in older patients does not seem to be associated with worse asthma control of symptoms but their influence in health-related quality of life could indirectly affect asthma control. 

Key words: Elderly asthma, Asthma control, ACT, Comorbidity, Health-related quality of life, AQLQ, Treatment adherence