CME: Treating Asthma in Older Women

CME: Treating Asthma in Older Women
Author Information (click to view)

Alan P. Baptist, MD, MPH

Director, University of Michigan Asthma Program at Dominos Farms
Associate Professor, Division of Allergy and Clinical Immunology
Department of Internal Medicine
Associate Professor, Health Behavior & Health Education
University of Michigan School of Public Health

Alan P. Baptist, MD, MPH, has indicated to Physician’s Weekly that he has served as advisor/consultant to Boehringer Ingelheim and Merck and has received research grants from Hoffman-La Roche and Merck.

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Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  1. Discuss specific issues that are unique to older women with asthma.
  2. Review strategies for improving the care of older women with asthma.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwsept6.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Christopher Cole – Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Alan P. Baptist, MD, MPH
Mr. Baptist has disclosed the following relevant financial relationships:
Consultant:  Boehringer Ingelheim;  Merck & Co.,Inc.
Contracted Research:  Hoffmann-LaRoche Inc.; Merck & Co., Inc.
 
 AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Alan P. Baptist, MD, MPH (click to view)

Alan P. Baptist, MD, MPH

Director, University of Michigan Asthma Program at Dominos Farms
Associate Professor, Division of Allergy and Clinical Immunology
Department of Internal Medicine
Associate Professor, Health Behavior & Health Education
University of Michigan School of Public Health

Alan P. Baptist, MD, MPH, has indicated to Physician’s Weekly that he has served as advisor/consultant to Boehringer Ingelheim and Merck and has received research grants from Hoffman-La Roche and Merck.

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Studies have shown that older women with asthma have disease-associated morbidity and mortality that is different from other patient populations. Physicians should consider using tailored treatment strategies to improve care in this vulnerable patient group.
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Among older individuals, women are significantly more likely than men to report having asthma and also have a 30% higher asthma-related mortality rate. In addition, women are nearly twice as likely to visit the emergency department for asthma when compared with men. Older women have been shown to have the highest hospitalization rates among all people with asthma (Figure). “However, little is known regarding why older women are more likely to suffer from the adverse events of asthma,” says Alan P. Baptist, MD, MPH. To better understand the specific issues that are unique to older women with asthma, Dr. Baptist and colleagues conducted a literature review and published their findings in Annals of Allergy, Asthma, & Immunology.

Unique Factors

Menopause and hormone replacement are unique features among older women that may play a role in how asthma affects them differently from others. “Adult women experience the most asthma exacerbations around age 50, which is also the average age of menopause,” explains Dr. Baptist. “Studies also show that hormonal changes during the menstrual cycle often play a large role in asthma symptoms. Although we can’t say menopause and asthma symptoms are definitely related, we did find data suggesting this may be the case.”

Dr. Baptists and colleagues also found that women with no history of asthma who were started on hormone replacement therapy were more likely to develop asthma than women who did not. “Conversely, among women who had asthma, hormone replacement actually improved symptoms and decreased asthma exacerbations,” Dr. Baptist says. “Hormone replacement therapy has many side effects, but it may be worthwhile to consider it in some women with asthma after carefully considering the risks and benefits for each person.”

Addressing Common Features

Dr. Baptist and colleagues also reviewed what they felt may be certain aspects of asthma in older women that are not seen in other populations. “For example, it has been well known that oral steroids can affect bone mineral density,” he says. ”And now some data show that use of inhaled corticosteroids—the cornerstone of chronic asthma treatment—significantly lowers bone mineral density among post-menopausal women, when compared with age-matched controls. Bone mineral density screening is therefore important among older women.” Aspirin, β-blockers, and NSAIDs used to treat comorbidities that are commonly used by older women may also worsen asthma.

More than half of adults with asthma report at least one comorbidity, and rates are higher among women and increase with age. “Comorbidities may be related to some of the worst outcome among older adults with asthma,” says Dr. Baptist. “Comorbidities can lead to depression, a comorbidity itself that is strongly associated with poor asthma control, especially among the elderly.” Dr. Baptist points to a previous study in which he and colleagues found that depression was more strongly associated with poor asthma quality of life and poor asthma control than were asthma severity, number of exacerbations, lung function testing, or other comorbidities. He suggests that clinicians screen for depression among older women with asthma.

Older women often serve as primary caregivers for loved ones with other chronic illnesses. “These women may overlook their own health while caring for others,” Dr. Baptist says. “Caregivers often experience stress and depression, which can potentiate one another and cause asthma to worsen.” He recommends asking older women with asthma about any caregiver duties. He also recommends that those with caregiver duties undergo screening for depression or stress and connecting these patients to appropriate resources, such as mental health professionals, social work services, and support groups.

Research suggests that about 10% of older adults live below the poverty line, many of whom are unable to afford medication or office visit copays or other expenses relating to healthcare access. “We found that limited income and poverty can affect asthma care among older women,” says Dr. Baptist. “It is important for physicians to address finances with these patients.”

Improving Care

Several strategies can help physicians improve the care of older women with asthma. Aside from understanding and addressing risk factors, Dr. Baptist recommends that physicians use peek flow meters to assess asthma control because older women may have a decreased perception of breathlessness. “We must also recognize that obesity plays a large role in asthma and that older women are frequently overweight or obese,” he says. “Furthermore, we need to understand that incorrect inhaler use is common in older adults but can be avoided with good teaching and keep in mind that certain medications may be less appropriate for older adults.”

Readings & Resources (click to view)

Baptist A, Hamad A, Patel M. Special challenges in treatment and self-management of older women with asthma. Ann Allergy Asthma Immunol. 2014;113:125-130. Available at www.annallergy.org/article/S1081-1206(14)00338-X/abstract.
Akinbami L, Moorman J, Bailey C, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief.. 2012;94:1-8.

Moorman J, Akinbami L, Bailey C, et al. National Surveillance of Asthma: United States, 2001-2010. Vital Health Stat 3. 2012;35:1-67.

Zemp E, Schikowski T, Dratva J, et al. Asthma and the menopause: a systematic review and meta-analysis. Maturitas. 2012;73:212-217.

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