Lung Disease as a Comorbidity in 1128 Women
with a Heart Condition
Noreen Clark, PhD, Mary Janevic, PhD, Melissa Valerio, PhD, Laurie Lachance, PhD, Alan Baptist, MD, MPH & Georgiana Sanders, MD
Introduction
More than half of people with asthma are also managing other
chronic health conditions. Among individuals age 65 to 74,
hypertension (51%) and heart disease (31%) are the most
common comorbidities with asthma (1). Recent research has
suggested that among people with asthma, those with additional
comorbidities are more likely to have asthma symptoms and
attacks (2).
Women with asthma or other lung diseases are more likely than
men to be simultaneously managing other conditions. Although
little is known about gender-specific issues with managing
multimorbidity, women have unique issues in asthma
management; for example, the exacerbating role of hormonal
fluctuations and body weight (3).
Methods
Sample: 1128 women with heart disease between the ages of
60-90 years (mean 72.5 years; 83% White, 15% African
American).
All participants were community-dwelling and treated by daily
heart medication for a cardiovascular condition (i.e., arrhythmia,
angina, myocardial infarction, congestive heart failure, or valvular
disease), as identified from patient rosters at clinics in three
urban areas in Michigan, and all agreed to participate in a heart-
disease management intervention trial.
Data collection: Telephone interviews were used to gather data
on health, quality of life, and self-management behaviors.
Respondents were asked about the presence of other major
health problems besides heart disease, as well as which
condition they considered their primary health problem.
Analysis: Using SPSS, we first calculated frequencies of the
most common conditions comorbid with heart disease. Next,
among women with asthma and other lung disease (e.g.,
emphysema, COPD), we calculated the percentages who
reported that they considered those conditions, and not heart
disease, to be their primary health problem. Finally, we used
independent-sample t-tests to compare mean self-rated health
(1=poor to 5=excellent) between women with asthma or lung
disease and women without those conditions.
Results
•The most common comorbidities with heart disease were
arthritis (n=276; 25%) and diabetes (n=207; 18%).
However, just over 9% of the women had lung disease. Of
these, 4% (n-45) had been diagnosed with asthma, and
another 5% (n=64) with other lung disease.
•Almost half (47%) of women with asthma considered it to
be their primary health condition, rather than heart disease.
•Among women with other lung disease, 39% considered it
to be their primary health condition, rather than heart
disease.
•Women with heart disease and comorbid asthma or other
lung disease had significantly lower self-ratings of health (5-
point scale: poor-excellent) than women with heart disease
but without these conditions (2.4 vs. 2.8: p=.000).
Figure 1: Prevalence of common comorbidities among women with heart disease,
age 60-90 (n=1128). Includes percentage of women with each condition who think
that it, and not heart disease, is their primary health problem.
At the University of Michigan
Results (continued)
Table 1: Mean self-rated health among women with heart disease and
selected comorbidities (1=poor to 5=excellent)
Disease status Mean
Entire sample of women with heart disease 2.8
Heart disease and diabetes 2.4
Heart disease and asthma or other lung disease 2.4
Heart disease and arthritis 2.6
Conclusions
Nearly 10% of older women who participated in heart disease
management education also reported lung conditions (asthma,
COPD, emphysema). Although their participation in the program
suggested they perceived a need for heart-disease management
support, a substantial percentage of women with asthma and other
lung diseases actually considered these illnesses to be their main
health problem. Previous work among women with asthma has
highlighted the need for education about concurrent management of
other diseases or conditions that are present, as these are likely to
complicate asthma management (4). For example, symptoms of
asthma/other lung disease and heart disease can be similar, which
can be a source of frustration for patients trying to determine the
appropriate medication to use (5). Findings suggest that clinicians
offering women disease-specific education programs and clinical
services need to consider the effect of comorbidities on self-
management of all conditions present, and to devise effective ways
to help women negotiate the demands of each.
References
1.) Asthma: The Impact of Multiple Chronic Conditions. Partnership for Solutions, Baltimore, MD, August
2004. www.partnershipforsolutions.org.
2) Zhang, T., Carleton, B.C., Prosser, R.J., Smith, A.M. (2009). The added burden of comorbidity in
patients with asthma. Journal of Asthma 46, 1021-1026.
3) Clark, N.M., Valerio, M.A., & Gong, Z. M. (2008). Self-regulation and women with asthma. Current
Opinion in Allergy and Clinical Immunology 8, 222-227.
4) Valerio, M.A., Gong, M., Wang, S., Bria, W.F., Johnson, T.R., Clark, N.M. (2009). Overweight women
and management of asthma. Women’s Health Issues 19, 300-305.
5.) Baptist, A.P., Bibban, B.K., Reddy, R.C., Nelson, B, Clark, N.M. (2010). Age-Specific Factors
Influencing Asthma Management by Older Adults. Qual Health Res 20: 117-124