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Underuse of inhaled steroid therapy in elderly patients with asthma


Study objectives — Despite their proven efficacy, inhaled steroids may be underused in the elderly asthmatic population. The objectives of this study were to determine if inhaled steroids areunderused in the elderly asthmatic population, who are at a high riskfor rehospitalization and mortality, and to identify certain riskfactors that predict lower use of inhaled steroids in this group of patients.

Design — Population-based, retrospective, cohort study using linked data from hospital discharge and outpatientdrug databases.

Participants — All people ≥ 65 yearsold in Ontario, Canada, who survived an acute exacerbation of asthmabetween April 1992 and March 1997.

Measurements and Results — Of the 6,254 patients, 2,495 patients (40%) did notreceive inhaled steroid therapy with in 90 days of discharge from theirinitial hospitalization for asthma. Patients > 80 years old were at agreater risk of not receiving inhaled steroid therapy, compared tothose 65 to 70 years of age (adjusted odds ratio [OR], 1.23; 95%confidence interval [CI], 1.05 to 1.47). Patients with a Charlsoncomorbidity index of ≥ 3 were also at an increased risk of notreceiving inhaled steroid therapy, compared to those having nocomorbidities (adjusted OR, 3.45; 95% CI, 1.56 to 7.69). Moreover, receipt of care from a primary-care physician was independentlyassociated with an elevated risk of not receiving inhaled steroidtherapy, compared to receipt of care from respirologists/allergists(adjusted OR, 1.35; 95% CI, 1.10 to 1.61).

Interpretation — Forty percent of Ontario patients ≥ 65years old who experienced a recent acute exacerbation of asthma did notreceive inhaled steroid therapy near discharge from their initialhospitalization for asthma. Nonreceipt of inhaled steroid therapy wasparticularly prominent in the older patients with multiplecomorbidities. Moreover, those who received care from primary-carephysicians were also less likely to receive inhaled steroid therapy, compared to those who received care fromspecialists.



Sin DD, Tu JV. Chest. 2001; 119(3):720-5.

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