Chest
Clinical InvestigationsCOPDAging and Disability Affect Misdiagnosis of COPD in Elderly Asthmatics: The SARA Study†
Section snippets
Subjects
We studied a subgroup of 128 asthmatic subjects (98 women, 76.6%) aged 73 ± 6.4 years (mean ± SD) enrolled in the Salute Respiratoria nell'Anziano (SARA) [respiratory health in the elderly] study. This is a multicenter Italian project aimed at investigating various aspects of chronic airway diseases in the elderly population. Twenty-four pulmonary or geriatric institutions, distributed throughout Italy, took part in the investigation (see Appendix). All eligible subjects ≥ 65 years old and
Results
Mean FEV1 percentage of predicted (FEV1%) in the entire sample was 70.7 ± 25.7%, and mean FEV1/FVC was 65.6 ± 13.3% (mean ± SD). Airway obstruction (FEV1/FVC < 70%) was detected in 60% of participants. The mean percentage increase in FEV1 after reversibility test was 14.4 ± 15.7%, with 50% showing an increase > 12%.
Discussion
The present study shows that in our population, one of five elderly asthmatic patients receives an improper diagnosis of COPD, and at least one of four asthmatic patients does not receive any diagnosis of respiratory disease. Older age and disability, together with a less typical clinical pattern, have been shown to significantly affect misdiagnosis, whereas a milder functional impairment appears to be a risk factor for underdiagnosis of asthma in the elderly. Male sex did not qualify as a risk
Conclusion
In summary, our results suggest that asthma in the elderly is frequently confused with COPD or not diagnosed. Older age and the greater degree of disability, together with a less typical clinical pattern, appear to be the main causes of misdiagnosis, even when smoking history and chronic sputum are not present. In addition, respiratory symptoms suggestive of asthma, such as wheezing, may be underestimated, especially in patients with mild disease.
Appendix
Study coordinators were V. Bellia (Palermo) and F. Rengo (Napoli). Scientific Committee members were R. Antonelli Incalzi (Rome), V. Grassi (Brescia), S. Maggi (Padua), G. Masotti (Florence), G. Melillo (Naples), D. Olivieri (Parma), M. Palleschi (Rome), R. Pistelli (Rome), M. Trabucchi (Rome), and S. Zuccaro (Rome).
Participating centers, principal investigators (in parentheses), and associated investigators (in brackets) were as follows: Divisione di Medicina 1°, Osp. Geriatrico INRCA, Ancona
ACKNOWLEDGMENT
All of the participants thank G. Torresin and the staff of Biomedin (Padua, Italy) for technical assistance.
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This study was supported by a research grant from Boehringer Ingelheim Italia.
The work was performed at the Istituto di Medicina Generale e Pneumologia, University of Palermo, Italy.
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A list of participants and participating institutions is given in the Appendix.