Current smoking and low HRQoL as strong predictive factors for acute care among elderly asthma patients
Objective : To examine risk factors for emergency visits among elderly asthma patients in a well-organized asthma care setting. Methods : The study population was a random sample of 344 patients visiting the Pulmonary Clinic of Helsinki University Hospitals (HUCH) with a diagnosis of asthma (J45-J46) during the years 1995-2006. 117 asthma patients had had at least one emergency visit and formed the active group. 227 patients without emergency visits formed the control group. Uni- and multivariate logistic regression was used to analyze the significance of several demographic and clinical variables for the need of emergency treatment. Results : The study population was on average 56 (SD 13) years old and 72 % of the patients were women. Follow-up among cases covered 799 patient years and on average 0.4 emergency visits per patient year was identified. Asthma, lower and upper respiratory infections were described as the discharge diagnosis in 45%, 17% and 6% of the visits, respectively. The cases were older, had suffered longer from asthma, had lower lung functions, and were more often ex- or current smokers. In the multivariate analysis current smoking and poor HRQoL (health related quality of life) remained independent risk factors for emergency room care (OR 3.9, CI 1.7-8.8 and OR 1.9, CI 1.2-3.0, respectively). Conclusions : Current smoking is a risk factor for the need of emergency care. Also those with self-estimated poor HRQoL are in a risk for emergency treatment. In this study population, enrolled in the special care setting, the promotion of smoking cessation might play an important role in prevention of acute hospital care among elderly asthma patients.