Older women with severe asthma may be at greatest risk for undertreatment, say researchers who assessed adherence to the National Asthma Education and Prevention Program medication guidelines among participants in the Nurses’ Health Study. Of the 5,107 women who reported physician-diagnosed asthma, only 57% with mild asthma, 55% with moderate asthma, and 32% with severe asthma were taking medications as advised by the guidelines.
The figures seemed somewhat baffling, especially considering that the women in the study were health care providers themselves. Psychosocial factors (e.g., marital status, social isolation), lack of insurance, and other possible influences could not completely account for the lack of adherence or the age gradient. Although the investigators had anticipated that low adherence among women with severe asthma would be a result of reluctance to use systemic corticosteroids, they found, in fact, that both those drugs and long-acting bronchodilators were underused.
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The greatest increase in asthma-related mortality today is among older women. The researchers urge health care providers to make greater efforts to evaluate asthma severity and to step up therapy when indicated.