2. Joyce Hogebrug
Specializing in clinical geriatrics
Quality of Life and Asthma Control in Elderly Asthmatics: a seven year follow-up – Results from the PRAXIS study
Bjorn Stallberg1, Joyce Hogebrug2, Christer Janson3, Mary Kämpe3, Scott Montgomery4, Tjard Schermer2, Josefin Sundh4, Karin Lisspers3 1Uppsala University, 2Radboud University Medical Centre, the Netherlands, 3Uppsala University, Sweden, 4Örebro University, Örebro, Sweden
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3. Declaration of interest
Bjorn Stallberg has received honoraria for educational activities/lectures/ advisory boards from AstraZeneca/Boehringer Ingelheim(BI)/GlaxoSmithKline/ Novartis/MEDA/TEVA.
Christer Janson has received honoraria for educational activities/lectures/advisory boards from AstraZeneca/BI/Chiesi/ Novartis/TEVA.
Karin Lisspers has received honoraria for educational activities/ lectures/advisory boards from AstraZeneca/GlaxoSmithKline/ Novartis/MEDA/Takeda.
Joyce Hogebrug, Mary Kämpe, Scott Montgomery, Tjard Schermer, Josefin Sundh had no conflict of interests related with the present study.
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4. What did I do?
≥60y
Add: why this study? And the aim
Why: First long-term (7 years) follow-up study on QoL & asthma control in elderly asthmatics. To optimise asthma management in clinical practice
Main aim: compare course of QoL and asthma control between 2005 and 2012 in older adults (aged ≥60 years)
Second aim: compare these outcomes with younger adults
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5. Methods Physician’s diagnosis of asthma
2005
56 PHCC's 14 hospitals
Excluded
PHCC's <3000 inhabitants
3 PHCC's declined
22 per PHCC 35 per hospital
Postal survey to: from PHCC's 499 from hospitals
Response rate 71%
1210 patients
54 deceased
5 lost to follow-up
patients
Response rate 65%
747 patients
Physician’s diagnosis of asthma
Attended centre/hospital in the last 4 years
Age (in 2005)
Of 747:
496 younger (≤ 59)
251 older (≥ 60).
Non-responders  no differences
2005: 98% records

6. Methods MiniAQLQ Asthma control according to GINA
Symptoms
Activity limitations
Emotional function
Environmental stimuli
15x
MiniAQLQ
Asthma control according to GINA
Best
Worst
Controlled vs Uncontrolled
MiniAQLQ:
15 questions, 4 domains: Symptoms (5Q), Activity limitations (4Q), Emotional function (3Q), Environmental stimuli (3Q)
7 point interval scale
Severe impairment (1)  no impairment (7)
Difference ≥0,5 = clinically relevant1
Asthma Control according to GINA:
Use of < 3 doses of short-acting β2-agonists per week (last week)
No night awakenings (last week)
No emergency visits to primary care or hospital (last 6 months)
No courses of oral steroids (last 6 months)
<3 doses
Of ß2
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7. Methods Statistics (SPSS): 2005 versus 2012; 7 years follow-up
Young (18-59y) versus old (≥60y) (both in 2005)
Multiple logistic regression: to evaluate baseline predictors for decreased QoL and uncontrolled asthma in 2012.
Possible predictors:
Age
Sex
BMI
Level of care
Educational level
Smoking status
Treatment level
Heart disease
Depression
Allergic symptoms
MiniAQLQ score 2005
Asthma control 2005
2005 versus 2012: paired-samples t-test or McNemar’s test.
Young versus old: independent-samples t-test or Chi2 test.
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8. Results – Quality of Life
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9. Results – Asthma Control
2005 vs 2012
Old: p = 0.002
Young: p = 0.003
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10. 26/05/2016

11. Results – predictors Ageing was not a predictor for either one.
Decreased Quality of Life 2012
Uncontrolled Asthma 2012
Quality of Life in 2005
Uncontrolled Asthma in 2005
Lower educational level
Having allergic symptoms
Being in a higher treatment level
Having a depression
Ageing was not a predictor for either one.
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12. Conclusions MiniAQLQ scores did not change in 7 years
Older asthmatics have a lower QoL
Ageing is no predictor for lower QoL over time
Asthma control got better in 7 years
No difference between young & old in 2012
Ageing is no predictor for uncontrolled asthma
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13. Questions?
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14. Patient characteristics
Follow-up 2012:
Younger group changed in BMI + smoking status
Older group changed in treatment level
Both groups:
2/3 female
70% primary care
Older group:
Lower educational level
More former smokers
Lower personal best of FEV1% predicted
More comorbidities (except depression)
Less allergic symptoms
Higher treatment level
More often late onset asthma
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15. Patient characteristics
Survey 2005
Survey 2012
Younger (18-59)
Older (60-75)
Younger
Older
N (mean, SD or %) p1 p2
Age N (mean, SD)
496 (44.0, 11.5)
251 (66.3, 4.4)
496 (50.3, 11.5)
251 (72.6, 4.4)
Sex
p = 0.870
Men
197 (39.7)
102 (40.6)
Women
299 (60.3)
149 (59.4)
BMI
p = 0.801
Young p < 0.001
Old p = 0.220
BMI < 18
3 (0.6)
1 (0.4)
4 (0.8)
BMI 18-25
187 (38.5)
85 (35.6)
148 (30.8)
88 (37.1)
BMI 25-30
192 (39.5)
103 (43.1)
202 (42.1)
90 (38.0)
BMI > 30
104 (21.4)
50 (20.9)
126 (26.3)
58 (24.5)
Educational level
p < 0.001
Low
232 (47.4)
187 (76.6)
High
257 (52.6)
57 (23.4)
Level of care
p = 0.723
Primary Care
346 (69.8)
179 (71.3)
Secondary care
150 (30.2)
72 (28.7)
Smoking status
p = 0.001
Young p = 0.003
Old p = 0.083
Current smoker
81 (16.4)
27 (10.8)
57 (11.7)
17 (6.9)
Former smoker
138 (27.9)
102 (40.8)
149 (30.5)
105 (42.5)
Never smoker
276 (55.8)
121 (48.4)
283 (57.9)
125 (50.6)
Personal best FEV1 % predicted;
N (mean, SD)
181 (90.1, 19.8)
90 (84.8, 23.0)
p = 0.049
Comorbidity
COPD3
14 (2.8)
21 (8.5)
Heart disease3
55 (22.2)
Hypertension3
56 (11.3)
72 (29.0)
Diabetes mellitus3
16 (3.2)
26 (10.5)
Depression3
36 (7.3)
16 (6.5)
p = 0.788
Allergic symptoms4
396 (79.8)
165 (66.0)
Treatment level5
p = 0.004
Young p = 0.070
Old p = 0.004
Step 1
119 (24.0)
36 (14.4)
138 (28.2)
51 (20.8)
Step 2
116 (23.4)
55 (22.0)
93 (19.0)
33 (13.5)
Step 3
261 (52.6)
159 (63.6)
259 (52.9)
161 (65.7)
Age at onset6
≤ 15 years
187 (38.6)
49 (21.3)
≥ 16 years
297 (61.4)
181 (78.7)
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16. Results – Treatment level
Y: 74.8
Y: 14.3
Treatment levels
Only short-acting ß2 agonists (SABA)
Inhaled cortico-steroids (ICS)
ICS & long-acting ß2 agonists (LABA)/ anti-leukotriene (LTRA)
Y: 10.9
Y: 24.3
Y: 22.8
Y: 23.3
Y: 45.6
Y: 52.4
Y: 31.6
Y: 8.9
Y: 9.3
Y: 81.7
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17. Relating to previously published work - QoL
Lower QoL in older:
More comorbidities
Lower functional status
Lower educational level
No decrease in QoL over the years:
Reduced perception bronchoconstriction
Attributing symptoms to other causes than asthma (eg ageing)
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18. Relating to previously published work – Asthma Control
Better asthma control after 7 years:
Better management (more awareness among physicians)
Higher treatment level
Proportion controlled asthma is according to previous research
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19. Future research Impact of comorbidities in elderly asthmatics
Impact of age of onset (different phenotypes)
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