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Editor's Correspondence
January 13, 2003

Elderly Asthmatic Patients—Reply

Arch Intern Med. 2003;163(1):122. doi:10.1001/archinte.163.1.122-a

In reply. We share with Drs Satoh and Sekizawa an interest in the important impact of comorbid illnesses on the management of respiratory diseases. They bring up the importance of comorbid coronary artery disease (CAD) and arrhythmia, which may increase the risk of hospitalization for patients with asthma. In our article,1 we focused on certain prespecified comorbid conditions. However, the survey we administered also included information about self-reported angina and history of prior myocardial infarction. We did not obtain information about arrhythmia. In our study, there was a strong, positive association between older age and a history of angina and/or myocardial infarction (18-34 years, 1.0%; 25-44 years, 2.0%; 45-54 years, 5.2%; 55-64 years, 11.4%; ≥65 years, 17.5%; P<.001). In addition, hospitalization for asthma was more likely in patients who had a history of CAD compared with those who did not (11.8% vs 4.5%;P<.001). In our article, the only hospitalizations that we assessed were those specifically for asthma. When we added CAD to our multivariate model, we found that it was independently and significantly associated with future hospitalizations (odds ratio, 1.53; 95% confidence interval, 1.03-2.29). Since we only assessed hospitalization for asthma and not for other indications, we cannot tell if there was a role of asthma medications on admissions for CAD. However, we suspect that a patient history of CAD may lower the admission threshold for patients with asthma and that it is possible that medications prescribed for CAD, such as aspirin and β-blockers, may increase the risk of asthma attacks. Therefore, we do not have information about additional causes for hospitalization in these patients with comorbid illnesses. These findings regarding patients with CAD highlight the increasing complexity of older patients with asthma compared with their younger counterparts.

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