Women’s Self-Management of Asthma

1. Women’s Self-Management of Asthma Noreen Clark, PhD Molly Gong, MD Melissa Valerio, MPH Sijian Wang, BS Xihong Lin, PhD William Bria, MD Timothy Johnson, MD University of Michigan School of Public Health

2. 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)

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

4. Study Participants • 652 women • 18 years and older • Physician diagnosis • Attending University of Michigan Asthma & Airways Clinic and University of Michigan Health System

5. Data collection Telephone interview • Demographics • Asthma symptoms • Health care utilization • Gender-related management • Peak flow meter use

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

7. Demographics: Age

8. Demographics: Education

9. Demographics: Income

10. Demographics: Race/Ethnicity

11. Findings

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

13. Demographics and Persistent Asthma • Women of minority, low income, less education, and unemployed were more likely to have persistent asthma

14. 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)

15. 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)

16. Demographics and Frequency of Using The Management Techniques • Lower education level and unemployment were associated with more use of management techniques.

17. Demographics and Believes of The Management Techniques • Lower education level was associated with higher level of belief in the management techniques.

18. 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.

19. 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.

20. Menstruation and Health Care Use • Women who menstruate had significantly more hospitalizations and scheduled doctor visits.

21. PMS and Asthma Health Care Use • Women who reported PMS Symptoms had more hospitalizations, ED visits, unscheduled doctor visits and doctor visits to follow-up an asthma episode

22. With Problems during Sexual Activity and Health Care Use • Women who reported asthma related problems during sexual activity had significantly more health care use.

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

24. 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.