title: Multidimensional assessment of older people with asthma and COPD: clinical management and health status.
abstract: BACKGROUND
  the diagnosis and management of obstructive airway diseases (OADs) such as asthma and chronic obstructive pulmonary disease (COPD) can be challenging in older people.
  
  
  OBJECTIVE
  to assess the clinical, functional, biological and behavioural characteristics relevant to the management of older people with OAD.
  
  
  METHODS
  a cross-sectional study was conducted in a tertiary teaching hospital. Older people (> 55 years) (n = 100) with an OAD underwent a multidimensional assessment (MDA) involving questionnaires, clinical assessments, physiological measurements and biomarkers.
  
  
  RESULTS
  the assessment identified a mean (SD) of 11.3 (2.5) clinical management issues and 3.1 (1.8) comorbid conditions per participant. Common problems were: airways hyper-responsiveness (80%); airway inflammation (74%); activity limitation (74%) and systemic inflammation (60.5%). The number and type of issues were similar irrespective of a diagnosis of asthma or COPD (P = 0.2). The degree of health status impairment correlated significantly with the number of clinical management issues detected (r = 0.59; P < 0.0001).
  
  
  CONCLUSIONS
  older people with OAD experience multiple clinical issues that adversely impact their health status. The number and type are similar irrespective of diagnosis. This MDA identifies significant clinical issues that may not be addressed in a diagnosis centred approach suggesting that a multidisciplinary approach is necessary when assessing and managing older people with OAD.
authors.affiliation: School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. vanessa.mcdonald@hnehealth.nsw.gov.au
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: McDonald
authors.forename: Jodie L
authors.initials: JL
authors.lastname: Simpson
authors.forename: Isabel
authors.initials: I
authors.lastname: Higgins
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D016535:Bronchial Hyperreactivity / Q000097:blood / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein