Prevalence and Correlates of Respiratory Symptoms and Disease in the Elderly: Discussion

The models for emphysema and chronic bronchitis suggest that for the same degree of airflow limitation and amount of cigarette smoking, physicians are twice as likely to give a diagnostic label of emphysema to men (than to women) and a diagnostic label of chronic bronchitis to women.
Not surprisingly, a diagnosis of asthma in the elderly is most strongly associated with attacks of wheezing with dyspnea in our univariate analysis and logistic regression model. Many of those with asthma also have baseline airways obstruction shown by spirometry (three to five times the risk compared with those without asthma). The negative association with pack-years of cigarette smoking suggests that physicians tend not to give a diagnostic label of asthma to smokers or that elderly persons with asthma tended not to take up smoking or quit smoking when they get asthma. Like chronic bronchitis, those seen at clinic 6 were less likely to get this diagnosis there flovent inhalers. The prevalence of reported physician-confirmed disease is affected by access to healthcare and the diagnostic habits of primary care physicians.
Airways obstruction seen in participants without physician-diagnosed emphysema, chronic bronchitis, or asthma may be considered as the result of sub-clinical or undetected airways disease, and may also be the result of left heart failure. Cigarette smoking remains the most important predictor of airways obstruction in this group of elderly participants. Both smoking status (current or former vs never smoking) and the cumulative amount of past cigarette smoking (pack-years) were strongly associated with impairment of lung function. Those with a history of chronic cough were three times as likely to have airways obstruction than were those without this symptom of airway inflammation. This suggests that a history of chronic cough in an elderly current or former cigarette smoker should lead a physician to order a spirometry test to detect airways obstruction.

This entry was posted in Pulmonary Function and tagged abnormality rates, elderly, respiratory symptoms.