Noreen Clark, PhD Molly Gong, MDMelissa Valerio, MPHSijian Wang, BSXihong Lin, PhDWilliam Bria, MD Timothy Johnson, MD

University of MichiganSchool of Public Health

Women’s Self-Management of Asthma

Background

Approximately 9.6 million women had asthma in 2001 compared to an estimated 5 million men (CDC, 2002).

Asthma disproportionately affects boys and women. Increases in the rate of asthma in women begin in adolescence (references)

Purpose

To examine demographic factors and symptoms associated with asthma self-management in women with asthma.

Study Participants

652 women 18 years and older Physician diagnosis Attending University of Michigan

Asthma & Airways Clinic and University of Michigan Health System

Data collection

Telephone interview

Demographics Asthma symptoms Health care utilization Gender-related management Peak flow meter use

Data Analyses

Logistic regression and Odds Ratios (OR) or Relative Risk (RR) were computed.

Demographics: Age

13%

7% 9%

21%

26%

24%

18-30

31-40

41-50

51-60

61-70

>71

Demographics: Education

22%

2%

26%

21%29%

< High School

High School

2-year College

4-year College

Post Grad

Demographics: Income

5%6%

16%

18%

16%

13%

15%

11%<10,000

10,001-20,000

10,001-20,000

40,001-60,000

60,001-80,000

80,000-100,000

>100,000

Not reported

Demographics: Race/Ethnicity

2%1%2%

10%

2%

83%Caucasian/White

African American/Black

Asian/Pacific Islander

Hispanic/Latino

Native American

Other

Findings

Asthma Severity

Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997

Percent of Women

Mild intermittent 52%

Mild persistent 15%

Moderate persistent 18%

Severe persistent 15%

Demographics and Persistent Asthma

OR P-value

Low income 1.76 .026

Less education 1.68 .003

Unemployed 1.71 .002

Race 0.546 .0073

Marriage 1.095 .5773

Women of minority, low income, less education, and unemployed were more likely to have persistent asthma

PFM use and Persistent Asthma

Results from logistic regression indicated that women with persistent asthma used more peak flow meters (OR=1.48, p=.03)

Management Behavior and Persistent Asthma

Results from Poisson regression type-3 test indicated that women with more severe asthma were more likely to adopt management techniques (p=.0001).

However, women’s beliefs about self-management and confidence in management behavior were not associated with their disease severity (p>.05)

Demographics and Frequency of Using The Management Techniques

Lower education level and unemployment were associated with more use of management techniques.

RR P-value

Married 1.0103 .6830

Low income 1.0658 .0810

Race 0.9480 .1041

Education 0.9204 .0014

unemployed 1.0999 .0003

Demographics and Believes of The Management Techniques

Lower education level was associated with higher level of belief in the management techniques.

RR P-value

Married 1.0163 .3740

Low income 0.9996 .9887

Race 0.9923 .7524

Education 0.9546 .0141

unemployed 0.9680 .937

Demographics and Confidence of Using the Management Techniques

Lower education level and unemployment were associated with higher level of confidence in using the management techniques.

RR P-value

Married 1.0245 .1930

Low income 0.9823 .5278

Race 0.9577 .0766

Education 0.9480 .0058

unemployed 1.0411 .0413

Hormone Related Findings

49% women currently menstruate. Among those, 16% noticed symptoms worsening during the week prior to the period, 97% women reported at least one PMS symptom.

36% women reported they were bothered by symptoms of asthma during sexual activity.

Menstruation and Health Care Use

RR P-value

hospitalization 1.42 0.02

ED visits 1.04 >.05

Unscheduled visits 1.01 >.05

Scheduled visits 1.29 .0056

Follow-up visits 1.06 >.05

Women who menstruate had significantly more hospitalizations and scheduled doctor visits.

PMS and Asthma Health Care Use

RR P-value

hospitalization 4.95 .0007

ED visits 1.79 .025

Unscheduled visits 2.01 .002

Scheduled visits 1.23 .38

Follow-up visits 1.81 .007

Women who reported PMS Symptoms had more hospitalizations, ED visits, unscheduled doctor visits and doctor visits to follow-up an asthma episode

With Problems during Sexual Activity and Health Care Use

RR P-valuehospitalization 1.42 .006

ED visits 1.51 .0001

Unscheduled visits 1.46 .0001

Scheduled visits 1.23 .0045

Follow-up visits 1.32 .0001

Women who reported asthma related problems during sexual activity had significantly more health care use.

Study Limitations

The study sample includes a number of women with high levels of education and income and an average age of 51 years.

Conclusions

Health care use maybe associated with sex and gender related management problems for women with asthma.

Severity of asthma is associated with use of more management techniques including peak flow meter usage.