Mortality in Western Australian seniors with chronic respiratory diseases: a cohort study

We identified 108,312 patients ≥ 65 years with CRD during 1992-2006 using linked medical, pharmaceutical, hospital and mortality databases held by the Commonwealth and State governments. Pharmacotherapy classification levels were designed by a clinical consensus panel. Cox regression was used to investigate the study aim.Patients using only short acting bronchodilators experienced similar, but slightly worse survival than patients in the highest pharmacotherapy level group using high dose inhaled corticosteroids (ICS) ± long acting bronchodilators (LABs) ± oral steroids. Patients using low to medium dose ICS ± LABs experienced relatively better survival. Also, male gender was associated with all-cause mortality in all patients (HR = 1.72, 95% CI 1.65-1.80) and especially in those in the highest pharmacotherapy level group (HR = 1.97, 95%CI = 1.84-2.10). The P-value of interaction between gender and pharmacotherapy level for the effect on all-cause death was significant (0.0003).Older patients with CRD not using ICS experienced the worst survival in this study and may benefit from an escalation in therapeutic regime. Males had a higher risk of death than females, which was more pronounced in the highest pharmacotherapy level group. Hence, primary health care should more actively direct disease management to mild-to-moderate disease patients.Asthma and Chronic Obstructive Pulmonary Disease (COPD) account for 80% of the total burden of chronic respiratory diseases (CRD) in Australia [1] and represent a significant burden to the Australian health care system [2,3]. They are nevertheless under-diagnosed among the older population because of atypical presentation and co-morbidity [2,4,5]. These diseases have similar manifestations in older patients - wheezing, chest tightness and shortness of breath - despite very different causes [6,7]. The estimated prevalence of asthma in Australian adults over 15 years of age ranges from 10 to 12% [3], whereas approximately 9-12% of A