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
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
7% 9%

13%

21% 18-30
31-40
41-50
51-60
24%
61-70
>71
26%
Demographics: Education
2%
22%
26%

< High School

High School

2-year College

4-year College

Post Grad
29%
21%
 Demographics: Income

11% 5%
6% <10,000
10,001-20,000
15% 16% 10,001-20,000
40,001-60,000
60,001-80,000

13% 80,000-100,000
18% >100,000
Not reported
16%
 Demographics: Race/Ethnicity

83%
2% Caucasian/White

1% African American/Black
2%
Asian/Pacific Islander
2%
Hispanic/Latino
10%
Native American

Other
Findings
 Asthma Severity

Percent of Women
Mild intermittent 52%

Mild persistent 15%

Moderate persistent 18%

Severe persistent 15%

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

RR P-value
Married 1.0103 .6830
Low income 1.0658 .0810
Race 0.9480 .1041
Education 0.9204 .0014
unemployed 1.0999 .0003

 Lower education level and unemployment

were associated with more use of
management techniques.
Demographics and Believes of 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

 Lower education level was associated with

higher level of belief in the management
techniques.
Demographics and Confidence of
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

 Lower education level and unemployment were

associated with higher level of confidence in using the
management techniques.
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-value
hospitalization 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.