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R. Graham Barr, MD, MPH; Samuel C. Somers, MD; Frank E. Speizer, MD; Carlos A. Camargo, Jr, MD, DrPH

Arch Intern Med. 2002;162:1761-1768.

Background  Asthma guidelines are well established but often followed poorly. Determinants of adherence among older persons may differ from younger persons and have not been well characterized.

Objectives  To assess adherence to asthma medication guidelines among older women with asthma and evaluate predictors of adherence with emphasis on asthma characteristics, comorbid medical conditions, work-related factors, social supports, caregiving, and emotional well-being.

Methods  We assessed adherence to the National Asthma Education and Prevention Program medication guidelines among participants in the Nurses' Health Study who reported a physician diagnosis of asthma and reconfirmed the diagnosis on a separate questionnaire, excluding those with chronic obstructive pulmonary disease.

Results  Among 121 700 participants in the Nurses' Health Study, 5107 reported physician-diagnosed asthma meeting inclusion criteria. Mean ± SD age was 63 ± 7 years in 1998. Adherence with asthma medication guidelines was 57% for mild persistent, 55% for moderate persistent, and 32% for severe persistent asthma (P = .001). In multivariate analysis, nonadherence was associated with severe asthma, increasing age, lower socioeconomic status, current smoking, earlier onset of asthma, and number of comorbid medical conditions. Measures of social isolation, caregiving, and emotional well-being were not associated with nonadherence.

Conclusions  Asthma is undertreated among older women, even those who are health care professionals. Women with advanced age and severe asthma were particularly at risk. Given that the greatest increase in asthma mortality has occurred among older women, further research is needed to examine physician prescribing patterns and patient beliefs in this vulnerable population.

From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (Drs Barr, Somers, Speizer, and Camargo), and General Medicine Division (Dr Barr) and Department of Emergency Medicine (Dr Camargo), Massachusetts General Hospital, Harvard Medical School, Boston.

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