title: Comparison of clinical management of young and elderly asthmatics by respiratory specialists and general practitioners.
abstract: BACKGROUND
  Asthmatic death in the elderly is a serious problem worldwide. Differences in clinical skill between respiratory specialists (RS) and general practitioners (GP) are important in asthma control. The aim of this study was to compare asthma management between RS and GP.
  
  
  METHODS
  A cross-sectional survey was carried out in Shimane, Japan, in February 2009 using a questionnaire about patient background, treatment, asthma control test (ACT) and adherence to treatment. We secured the cooperation of 48 clinics (39 private clinics and 9 general hospitals). Asthmatics were divided into the elderly and young groups, and also into the RS and GP groups.
  
  
  RESULTS
  Clinical data of 779 patients were available for analysis. Elderly patients constituted 464 (RS group: 192, GP group: 272), while those of the young group were 315 (RS group: 207, GP group: 108). RS prescribed inhaled corticosteroids (ICSs) to their elderly and young patients more than GP. The total ACT score was higher in young RS group than in young GP group, but no such difference was noted in the elderly. Despite more asthma-related symptoms, the ACT showed that elderly GP asthmatics used fewer rescue inhalers than elderly RS. Self-assessment was higher in elderly GP than elderly RS asthmatics. Adherence to therapy was better in elderly patients than young patients.
  
  
  CONCLUSIONS
  Elderly asthmatics treated by GPs underestimated the severity of their asthma and asthmatics seen by GPs were undertreated. The results stress the need to engage patients in educational activities, to adhere to guidelines, and to improve the coordination between GP and RS.
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine , Shimane , Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tada
authors.forename: Takashige
authors.initials: T
authors.lastname: Kuraki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Taooka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fuchita
authors.forename: Fumi
authors.initials: F
authors.lastname: Karino
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Miura
authors.forename: Shunichi
authors.initials: S
authors.lastname: Hamaguchi
authors.forename: Miki
authors.initials: M
authors.lastname: Ohe
authors.forename: Akihisa
authors.initials: A
authors.lastname: Sutani
authors.forename: Takeshi
authors.initials: T
authors.lastname: Isobe
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D062072:Patient Acuity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D013038:Specialization; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Adherence; asthma; asthma control test; asthmatic death; elderly patient