Season 2: Episode 7 - Asthma in Older Adults and the Hidden Risk in Long-Term Care

Andie Cartwright

Welcome to the Better Living Through Data podcast. Today we're going to talk about National Asthma and Allergy Awareness Month. Anthony, did you know that more than 106 million people in the U.S. have asthma and-or allergies, and somehow older adults still disappear from the picture. That number is so big it should make this impossible to ignore, but when people talk about asthma, they usually picture kids, maybe spring pollen, maybe an inhaler in a backpack. They do NOT picture an 82-year-old in post-acute care who can't sleep through the night because breathing got harder, or who stops walking as much because shortness of breath starts to feel normal.

Anthony Pero

And that mismatch matters. Of those 106 million, about 28 million people in this country have asthma. Twenty-eight million. But in older adults, asthma often shows up wearing someone else's name tag. It's written off as deconditioning, COPD, heart failure, anxiety, age, frailty -- pick your label. So the issue becomes less "does the patient have symptoms?" and more "did the system correctly SEE the symptoms?"

Andie Cartwright

The phrase "wearing someone else's name tag" is gonna stick with me. Because from a marketing lens, that's a visibility problem, right? Wrong category, wrong message, wrong response. If an older adult is coughing at night, getting fatigued, skipping activities, waking up breathless -- those are life signals. But if everybody around them shrugs and says, well, they're older... then severity gets underestimated before care even starts.

Anthony Pero

Exactly. And in aging populations, asthma rarely arrives alone. That's the other complication. You may have cardiovascular disease, metabolic disorders, other respiratory diagnoses, mood disorders, mobility limitations. So when an exacerbation happens, it's not just a clean textbook event. It can mean a hospitalization, an ER visit, a decline in function, a longer recovery, maybe even a readmission. The downstream impact is bigger.

Andie Cartwright

Let me push on that, though. Are we at risk of turning every breathing complaint in an older adult into an asthma story? Because that can happen too -- everybody wants a neat explanation.

Anthony Pero

That's fair. And no, the answer isn't to over-call it. It's to sharpen the lens. National Asthma and Allergy Awareness Month has been observed since 1984, and one of the most useful things about an awareness month is that it forces you to ask who's still being missed after all these years. For older adults, the question isn't "let's assume asthma." It's "let's stop assuming it's NOT asthma, or that it doesn't matter."

Andie Cartwright

Since 1984 is a long runway. That's four decades of awareness, and still the older adult angle can feel like a footnote. And I think that's where the human side hits. If asthma worsens sleep, that affects cognition and mood. If it worsens mobility, people pull back from rehab, social time, even just walking to meals. Quality of life can shrink quietly, one compromise at a time.

Anthony Pero

Right -- and that's where the community piece becomes real, not sentimental. Asthma isn't managed in isolation. In long-term care or post-acute settings, the "community" might be nursing staff, respiratory therapists, prescribers, family caregivers, even facility leadership and policy. If that support network catches patterns early, symptoms can be managed day to day. If it doesn't, the patient just looks progressively more fragile, and everyone accepts the decline as inevitable.

Andie Cartwright

That's the tension, isn't it? What's actually inevitable versus what's just unmeasured. Because those are VERY different things.

Anthony Pero

Yes. And from a life sciences perspective, unmeasured usually means under-treated, under-studied, or excluded from evidence generation. Older adults in post-acute and long-term care are exactly where we need better visibility. Not just for academic curiosity -- for practical decisions about risk, treatment, and what good daily living even looks like.

Andie Cartwright

Okay, so let's make that concrete. Because "better visibility" can sound noble and fuzzy. What do we actually have that changes the picture?

Anthony Pero

PointClickCare Life Sciences has a specially curated asthma dataset built for research. And the scale is meaningful: nearly 1 million unique patient records with asthma, and as of today more than 80,000 active unique asthma patients currently residing in our facilities. Those aren't abstract claims. That's a living view into asthma across long-term and post-acute care populations, where aging and complexity are the rule, not the exception.

Andie Cartwright

I wanna stop on the 80,000 active patients. Because "active" is the part that changes the feel of it for me. Nearly 1 million tells me breadth. Over 80,000 active patients tells me this isn't some dusty archive -- it's current enough to ask, who's struggling NOW?

Anthony Pero

That's exactly right. And it's sitting inside a broader long-term and post-acute care data environment that captures, on average, more than 50 points per patient per day, across more than 15 million patients age 65 and older, spanning over 10 years, with an average long stay over 800 days. So when we talk about older adults with asthma, we're not looking at one isolated visit. We can observe patterns over time.

Andie Cartwright

Fifty-plus points per patient per day is a lot. That's not a snapshot -- that's almost like security camera footage for health status. Maybe less flattering lighting, but still. So what kinds of things are actually visible in the asthma data set?

Anthony Pero

Several categories that matter a lot. Clinical utilization and outcomes: asthma-related hospitalizations, ER visits, frequency of exacerbations, length of stay, readmission rates. Respiratory function and symptoms: peak expiratory flow, FEV1-FVC, bronchodilator response, shortness of breath, cough, difficulty breathing. Biomarkers and labs: eosinophil count, IgE levels, oxygen saturation, glucose, temperature, respiration, weight, pulse, blood pressure. Then medication utilization -- corticosteroids like fluticasone, budesonide, beclomethasone; rescue inhalers like albuterol, salbutamol, levalbuterol; and biologics including omalizumab, tezepelumab, mepolizumab, benralizumab.

Andie Cartwright

Wait -- omalizumab to benralizumab in the same view? That's useful because it tells you this isn't just "does the patient have asthma." It's what kind of treatment intensity is happening, how often rescue meds show up, whether someone looks controlled on paper but unstable in real life.

Anthony Pero

Exactly. And it keeps going. We can look at health-related quality of life and functional indicators -- abilities, goals, fatigue, allergies, mental status measures. We can examine SDOH and DEI profiles like social isolation, health literacy, age, gender, sexual orientation, payer type. We also have lifestyle and behavioral factors such as smoking status, anxiety, depression, mood disorders. And then full comorbidity profiles through ICD-10 diagnosis listings, including respiratory, cardiovascular, and metabolic disorders.

Andie Cartwright

Social isolation and health literacy -- those two jump out. Because if an older adult misses inhaler technique, or doesn't report worsening symptoms, or lives in a setting where no one's connecting the dots, that's not just a clinical miss. It's an environment miss. It reminds me that "power of community" isn't a slogan. It's whether the people around you help translate symptoms into action.

Anthony Pero

Yes, and for researchers and pharma, that's where the data gets really relevant. Not every older adult with asthma carries the same risk. One patient may have repeated ER visits. Another may show gradual functional decline, poor sleep, low oxygen saturation, rising symptom burden, and depression -- without the dramatic acute event that gets everyone's attention. Better data helps identify both kinds of risk.

Andie Cartwright

So let me try to say it back. It's not just predicting who lands in the hospital. It's also spotting who is losing day-to-day life before they become a utilization statistic.

Anthony Pero

That's well put. Hospitalization is important, but it's not the whole story. If we can understand which older adults are most likely to exacerbate, decline functionally, cycle through rescue medication, or struggle because asthma is tangled up with comorbidities and social factors, then interventions get smarter. Care teams can prioritize. Researchers can stratify populations better. Pharma can design studies and evidence strategies that reflect the real aging population instead of a cleaner, younger version of asthma.

Andie Cartwright

And maybe the bigger shift is this: once you can actually see older adults with asthma clearly, it's harder to accept "that's just aging" as an answer.

Anthony Pero

Yeah. In May, awareness should do more than remind us asthma exists. It should force a better question: among those 28 million people with asthma, how many older adults have been hiding in plain sight because our data, our assumptions, or our care models weren't built to notice them?

Andie Cartwright

That is a really good point! Hey Anthony, I want to remind our listeners that accessing our data and really digging in is as easy as signing up for Study Buddy, our new AI-powered research tool!

Anthony Pero

That’s right, Andie. Right now, our listeners can sign up for free and try Study Buddy out! Simply sign up a the link in today’s episode description. Alright, this brings us to the end of today’s episode. Thanks, Andie.

Andie Cartwright

Thanks, Anthony! Bye Everyone!