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* From the Department of Medicine (Dr. Tu), Sunnybrook and Women’s College Health Science Center, University of Toronto, Toronto, Ontario; and Department of Medicine (Dr. Sin), University of Alberta, Edmonton, Alberta, Canada.
Correspondence to: Don D. Sin, MD, 2E4.39 Walter C. MacKenzie Center, University of Alberta, Edmonton, Alberta, Canada, T6G 2B7; email: don.sin{at}ualberta.ca
Study objectives: Despite their proven efficacy, inhaled steroids may be underused in the elderly asthmatic population. The objectives of this study were to determine if inhaled steroids are underused in the elderly asthmatic population, who are at a high risk for rehospitalization and mortality, and to identify certain risk factors that predict lower use of inhaled steroids in this group of patients.
Design: Population-based, retrospective, cohort study using linked data from hospital discharge and outpatient drug databases.
Participants: All people 
65 years
old in Ontario, Canada, who survived an acute exacerbation of asthma
between April 1992 and March 1997.
Measurements and
results: Of the 6,254 patients, 2,495 patients (40%) did not
receive inhaled steroid therapy within 90 days of discharge from their
initial hospitalization for asthma. Patients > 80 years old were at a
greater risk of not receiving inhaled steroid therapy, compared to
those 65 to 70 years of age (adjusted odds ratio [OR], 1.23; 95%
confidence interval [CI], 1.05 to 1.47). Patients with a Charlson
comorbidity index of 3 were also at an increased risk of not
receiving inhaled steroid therapy, compared to those having no
comorbidities (adjusted OR, 3.45; 95% CI, 1.56 to 7.69). Moreover,
receipt of care from a primary-care physician was independently
associated with an elevated risk of not receiving inhaled steroid
therapy, compared to receipt of care from respirologists/allergists
(adjusted OR, 1.35; 95% CI, 1.10 to 1.61).
Interpretation: Forty percent of Ontario patients 65
years old who experienced a recent acute exacerbation of asthma did not
receive inhaled steroid therapy near discharge from their initial
hospitalization for asthma. Nonreceipt of inhaled steroid therapy was
particularly prominent in the older patients with multiple
comorbidities. Moreover, those who received care from primary-care
physicians were also less likely to receive inhaled steroid therapy,
compared to those who received care from
specialists.
Key Words: asthma • comorbidities • elderly • inhaled steroids • underuse
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