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Hansen ESH, Rasmusen HK, Hostrup M, Hellsten Y, Backer V. The effect of aerobic exercise training on asthma control in postmenopausal women (ATOM): a randomized controlled pilot study. Eur Clin Respir J 2023; 10:2251256. [PMID: 37674777 PMCID: PMC10478610 DOI: 10.1080/20018525.2023.2251256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To evaluate if high-intensity interval training three times weekly for 12 weeks improves asthma control in overweight, postmenopausal women with uncontrolled, late-onset asthma. Methods The reported study is a randomized clinical pilot study (www.clinicaltrials.gov; NCT03747211) that compared 12 weeks of high-intensity interval training (spinning) with usual care. The five-question Asthma Control Questionnaire (ACQ-5) was used as primary outcome. Secondary measures included systemic inflammation and inflammation of the airways, body composition, and cardiac function during exercise. Results We included 12 women with asthma (mean age 65 years (SD 6); mean body mass index 30 kg/m2 (SD 2)) from whom eight were randomized to exercise and four to control. Baseline ACQ-5 was 1.95 (SD 0.53) in the control group and 2.03 (0.54) in the exercise group. Patients had a mean blood eosinophil level of 0.16 × 109cells/L (SD 0.07) and a mean fraction of exhaled nitric oxide of 23 ppb (SD 25). Mixed models showed that participants in the exercise group reduced their ACQ-5 by 0.55 points (95%CI -1.10 to -0.00; P = 0.08) compared with the control group. The exercise group significantly reduced their mean body fat percentage (-2.7%; 95%CI -4.5 to -0.8; P = 0.02), fat mass (-2.8 kg; 95%CI -5.1 to -0.4; P = 0.044) and android fat mass (-0.33 kg; 95%CI -0.60- -0.06; P = 0.038). In analyses of cardiac measures, we saw no significant effects on right ventricular function (fractional area change), diastolic function or left ventricular function. Conclusions Although changes in ACQ-5 were slightly insignificant, these preliminary findings indicate that aerobic exercise training can be used as a means to improve asthma control in overweight, postmenopausal women with asthma.
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Affiliation(s)
- Erik Sören Halvard Hansen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark
| | | | - Morten Hostrup
- Department of Nutrition Exercise and Sports, University of Copenhagen, CopenhagenDenmark
| | - Ylva Hellsten
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, CopenhagenDenmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology, Rigshospitalet, CopenhagenDenmark
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Perpiñá M, Gómez-Bastero A, Trisán A, Martínez-Moragón E, Álvarez-Gutiérrez FJ, Urrutia I, Blanco-Aparicio M. Expert consensus recommendations for the management of asthma in older adults. Med Clin (Barc) 2022; 159:53.e1-53.e14. [PMID: 34226059 DOI: 10.1016/j.medcli.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.
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Affiliation(s)
- Miguel Perpiñá
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Andrea Trisán
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - Isabel Urrutia
- Unidad de Asma y Enfermedades Ocupacionales-Medioambientales, Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, España
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Hansen ESH, Hostrup M, Rasmusen HK, Hellsten Y, Backer V. Effect of aerobic exercise training on asthma control in postmenopausal women (the ATOM-study): protocol for an outcome assessor, randomised controlled trial. BMJ Open 2021; 11:e049477. [PMID: 33888532 PMCID: PMC8070869 DOI: 10.1136/bmjopen-2021-049477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Late-onset asthma in postmenopausal women is characterised by poor disease control with daily symptoms and reduced quality of life despite treatment with inhaled antiasthma therapies. These patients represent a phenotype that is characterised by low eosinophilic airway inflammation, severe symptoms, moderate obesity and poor response to inhaled antiasthma therapies, which highlights the need of identification of alternative treatment strategies. Thus, this study aims to evaluate if regular high-intensity aerobic exercise improves symptom control in postmenopausal women with asthma. METHODS AND ANALYSIS This is an ongoing randomised controlled trial planning to enrol 40 postmenopausal women with late-onset asthma. Participants are randomised 1:1 either to supervised exercise training (spinning) three times per week for 12 weeks or to usual care. The primary outcome is change from baseline to follow-up in the Asthma Control Questionnaire. Secondary outcomes are changes in markers of systemic inflammation, airway inflammation, body composition and right ventricular function of the heart. ETHICS AND DISSEMINATION The study is approved by the Ethics Committee in the Capital Region of Denmark nr. H-18028966 and the Danish Data Protection Agency nr. VD-2019-59. The methods used in the study are well known and have a low risk with a chance of substantial improvement in disease control in this patient group. Results are planned to be published in an international peer-reviewed medical journal regardless of outcome. TRIAL REGISTRATION NUMBER NCT03747211.
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Affiliation(s)
- Erik Sören Halvard Hansen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Hostrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Kruuse Rasmusen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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4
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Yuan L, Wang L, Du X, Qin L, Yang M, Zhou K, Wu M, Yang Y, Zheng Z, Xiang Y, Qu X, Liu H, Qin X, Liu C. The DNA methylation of FOXO3 and TP53 as a blood biomarker of late-onset asthma. J Transl Med 2020; 18:467. [PMID: 33298101 PMCID: PMC7726856 DOI: 10.1186/s12967-020-02643-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Late-onset asthma (LOA) is beginning to account for an increasing proportion of asthma patients, which is often underdiagnosed in the elderly. Studies on the possible relations between aging-related genes and LOA contribute to the diagnosis and treatment of LOA. Forkhead Box O3 (FOXO3) and TP53 are two classic aging-related genes. DNA methylation varies greatly with age which may play an important role in the pathogenesis of LOA. We supposed that the differentially methylated sites of FOXO3 and TP53 associated with clinical phenotypes of LOA may be useful biomarkers for the early screening of LOA. METHODS The mRNA expression and DNA methylation of FOXO3 and TP53 in peripheral blood of 43 LOA patients (15 mild LOA, 15 moderate LOA and 13 severe LOA) and 60 healthy controls (HCs) were determined. The association of methylated sites with age was assessed by Cox regression to control the potential confounders. Then, the correlation between differentially methylated sites (DMSs; p-value < 0.05) and clinical lung function in LOA patients was evaluated. Next, candidate DMSs combining with age were evaluated to predict LOA by receiver operating characteristic (ROC) analysis and principal components analysis (PCA). Finally, HDM-stressed asthma model was constructed, and DNA methylation inhibitor 5-Aza-2'-deoxycytidine (5-AZA) were used to determine the regulation of DNA methylation on the expression of FOXO3 and TP53. RESULTS Compared with HCs, the mRNA expression and DNA methylation of FOXO3 and TP53 vary significantly in LOA patients. Besides, 8 DMSs from LOA patients were identified. Two of the DMSs, chr6:108882977 (FOXO3) and chr17:7591672 (TP53), were associated with the severity of LOA. The combination of the two DMSs and age could predict LOA with high accuracy (AUC values = 0.924). In HDM-stressed asthma model, DNA demethylation increased the expression of FOXO3 and P53. CONCLUSIONS The mRNA expression of FOXO3 and TP53 varies significantly in peripheral blood of LOA patients, which may be due to the regulation of DNA methylation. FOXO3 and TP53 methylation is a suitable blood biomarker to predict LOA, which may be useful targets for the risk diagnosis and clinical management of LOA.
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Affiliation(s)
- Lin Yuan
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
- Basic and Clinical Research Laboratory of Major Respiratory Diseases, Central South University, Changsha, Hunan, China
| | - Leyuan Wang
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Xizi Du
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Ling Qin
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Basic and Clinical Research Laboratory of Major Respiratory Diseases, Central South University, Changsha, Hunan, China
| | - Ming Yang
- Centre for Asthma and Respiratory Disease, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Kai Zhou
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Mengping Wu
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Yu Yang
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Zhiyuan Zheng
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Basic and Clinical Research Laboratory of Major Respiratory Diseases, Central South University, Changsha, Hunan, China
| | - Yang Xiang
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Xiangping Qu
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Huijun Liu
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Xiaoqun Qin
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China
| | - Chi Liu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Department of Physiology, Xiangya School of Basic Medicine Science, Central South University, Changsha, 410078, Hunan, China.
- Research Center of China-Africa Infectious Diseases, Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
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Abstract
PURPOSE OF REVIEW Asthma is a chronic heterogeneous respiratory disease which is characterized by airflow limitation and variable respiratory symptoms. Asthma in patients more than 65 years of age has an important negative impact on quality of life. The pathophysiology and treatment of asthma in older patients are not as well identified as in younger groups of ages. In this review we intend to outline characteristics found in elderly adults which distinguish them from other age groups of patients with asthma. RECENT FINDINGS With increasing age, there are alterations in the innate and adaptive immune responses, known as 'immunosenescence.' These age-associated modifications include an altered response after a pathogenic exposure or tissue injury, moderately mediated through an irreversible loss of cellular replication and defective tissue repair. SUMMARY Asthma is a consequence of complex gene-environment interactions, with diversity in clinical presentation and the type and intensity of airway inflammation and remodeling. Age-associated changes in lung physiology and morphology may occur and contribute to asthma. Aging is correlated with a notable decrease in elastic recoil, greater chest wall rigidity, and poor respiratory muscle strength. Underreporting of symptoms by elderly patients is common because of multiple underlying causes. VIDEO ABSTRACT: http://links.lww.com/COAI/A17.
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Trinh HKT, Nguyen TVT, Kim SH, Cao TBT, Luu QQ, Kim SH, Park HS. Osteopontin contributes to late-onset asthma phenotypes in adult asthma patients. Exp Mol Med 2020; 52:253-265. [PMID: 32009132 PMCID: PMC7062758 DOI: 10.1038/s12276-020-0376-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 01/07/2023] Open
Abstract
Patients with late-onset asthma (LOA) have poor clinical outcomes. Osteopontin (OPN) is associated with airway inflammation and remodeling. To investigate the role of OPN in LOA compared to early-onset asthma (EOA), serum OPN levels were compared between 131 adult asthma patients (48 LOA and 83 EOA patients) and 226 healthy controls (HCs). BALB/c mice were sensitized with ovalbumin with/without polyinosinic-polycytidylic acid (poly(I:C)) from week 6 (A6 mice) or week 12 (A12 mice) after birth. Airway hyperresponsiveness (AHR), bronchoalveolar lavage fluid (BALF), cell counts, histology, and Spp1 expression were assessed. The levels of OPN, transforming growth factor β1 (TGF-β1), chitinase 3-like 1 (CH3L1), and interleukin (IL) 5 were measured by ELISA. The expression of Smad3 phosphorylation and tissue transglutaminase 2 (TGM2) was evaluated by Western blot. The serum OPN levels were significantly higher in asthma patients than in HCs and in LOA patients than in those with EOA (P < 0.05) and were positively correlated with serum TGF-β1 and CH3L1 (r = 0.174, r = 0.264; P < 0.05). A12 mice showed elevated AHR with increased levels of OPN/TGF-β1/IL-5 in BALF and Spp1 compared to A6 mice. Poly(I:C) induced remarkable TGF-β1, CH3L1, Th2 cytokine, and OPN levels in BALF and the expression of phosphorylated Smad3, TGM2, and Spp1 in the lungs. OPN triggered TGF-β1/Smad3 signaling in the lungs, which was suppressed by dexamethasone and anti-IL5 antibody. In conclusion, aging and exposure to viral infections may induce OPN release and consequently modulate inflammation and TGF-β1/Smad3-related remodeling, contributing to the development of LOA. Aging and viral infections in older individuals may combine to spur the release of an inflammatory protein implicated in late-onset asthma. A team led by Hae-Sim Park from Ajou University School of Medicine, Suwon, South Korea, showed that people who develop asthma after age 40 have higher blood levels of osteopontin, a multifunctional protein with roles in airway inflammation and tissue remodeling, than people who develop asthma at a younger age or healthy individuals. The researchers developed two ovalbumin-induced asthma models in younger and older mice, and found that older mice developed more severe airway hyperresponsiveness with higher levels of osteopontin, among other inflammatory markers, which were emnhanced by viral infection. Drug therapies that target osteopontin signaling could help combat the late-onset asthma.
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Affiliation(s)
- Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Suwon, South Korea.,Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thuy Van Thao Nguyen
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Seo-Hee Kim
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, South Korea
| | - Thi Bich Tra Cao
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, South Korea
| | - Quoc Quang Luu
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, South Korea
| | - Seung-Hyun Kim
- Translational Research Laboratory for Inflammatory Disease, Clinical Trial Center, Ajou University Medical Center, Suwon, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University Medical Center, Suwon, South Korea. .,Department of Biomedical Science, Graduate School of Ajou University, Suwon, South Korea.
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7
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Caminati M, Vianello A, Ricci G, Festi G, Bellamoli R, Longhi S, Crivellaro M, Marcer G, Monai M, Andretta M, Bovo C, Senna G. Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy. World Allergy Organ J 2019; 12:100046. [PMID: 31320967 PMCID: PMC6612754 DOI: 10.1016/j.waojou.2019.100046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/18/2019] [Accepted: 06/10/2019] [Indexed: 01/21/2023] Open
Abstract
Background Asthma still represents a cause of death and hospital admissions worldwide. Our study aimed at analyzing the trend of Emergency Room (ER) asthma admissions in Northeast Italy in order to investigate the relevance of specific patient-related determinants and environmental triggers (pollens, mold spores, and pollutants). Methods Retrospective data from admissions for asthma exacerbations registered between the years 2013 and 2015 in two main ERs in Northeast Italy were collected. Data about patients' age, sex and nationality were recorded. Classification of disease severity followed the current Italian ER triage scoring system (white: no need for emergency treatment; green: need for fast treatment; yellow: severe condition; red: life-threatening condition). Data on pollen/mold spore counts and pollutants were analyzed. Results Overall, 1745 ER admissions for asthma were registered, with a persistent and significant increase year by year. A slight prevalence of females and patients over 50 years old was observed. Immigrants accounted for 32%, 36% and 26% of admissions respectively in 2013, 2014 and 2015. The prevalence of immigrants' admissions was significantly higher when comparing the relative ratio of immigrant populations/Italian nationals (p < 0.05). The admissions were coded as follows: white, 6.30%; green, 35.36%; yellow, 39.37%; red, 18.97%. People aged ≥50 years were more frequently admitted with a red code, but the trend was not statistically significant (p = 0,0815). By contrast, amongst immigrants there was a higher prevalence of white and green codes observed in comparison with Italian nationals. Grass pollen peak and PM10 high levels represented environmental determinants of ER admissions increase. Conclusions The increasing rate of asthma-related ER admissions highlights the need for implementing asthma control strategies. Investigating the traits of patients referring to ER for asthma exacerbations, as well as environmental-related determinants, may help in identifying at-risk individuals and in orienting preventive strategies accordingly. Immigrants represent the most vulnerable sub-population, and their potential difficulties in accessing treatments and health services should be specifically addressed. Overall, implementing patient education in order to improve treatment adherence, as well as providing an asthma action plan to every asthmatic patient, continue to be the most urgent needs.
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Affiliation(s)
- Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - Giorgio Ricci
- Emergency Department, Clinical Toxicology Unit, Verona University and General Hospital, Verona, Italy
| | - Giuliana Festi
- Respiratory Unit and Asthma Center, Verona University and General Hospital, Verona, Italy
| | - Roberto Bellamoli
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Sofia Longhi
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Mariangiola Crivellaro
- Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy
| | - Guido Marcer
- Respiratory Unit and Asthma Center, Verona University and General Hospital, Verona, Italy
| | - Marco Monai
- Meteorological Service, Veneto Regional Agency for Environment Protection and Prevention, Padua, Italy
| | | | - Chiara Bovo
- Medical Direction, Verona University and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
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Baarnes CB, Andersen ZJ, Tjønneland A, Ulrik CS. Determinants of incident asthma-COPD overlap: a prospective study of 55,110 middle-aged adults. Clin Epidemiol 2018; 10:1275-1287. [PMID: 30288123 PMCID: PMC6161740 DOI: 10.2147/clep.s167269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aim Knowledge of the impact of social determinants driving asthma– chronic obstructive pulmonary disease overlap (ACO) is lacking. Our objective was to identify determinants of incident ACO. Methods A total of 55,053 adults (50–64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993–97) was followed in the National Patient Registry for admissions for asthma (DJ45–46) and chronic obstructive pulmonary disease (COPD; DJ40–44) and vital status. Incident ACO was defined as at least one hospital admission for both asthma and COPD (different time points, one after baseline). Detailed case history was obtained at baseline. Cox proportional hazards model was used to examine associations between possible determinants and incident ACO, in terms of hazard ratio (HR) and 95% confidence interval (CI). Results During follow-up, 561 incident cases of ACO were identified. Age (HR 4.4, 95% CI 3.3–5.9, age group 60–65 years), current smoking (HR 3.6, 95% CI 2.8–4.6), unemployment (HR 1.5, 95% CI 1.2–1.8), and being divorced (HR 1.5, 95% CI 1.2–1.9) determined a higher risk of incident ACO, whereas the opposite was found for leisure-time physical activity (HR 0.7, 95% CI 0.6–0.8) and high educational level (HR 0.7, 95% CI 0.5–0.9). In contrast to ACO, preexisting myocardial infarction (MI; HR 1.5, 95% CI 1.2–1.8) and stroke (HR 1.5, 95% CI 1.2–1.9) were associated with a higher risk of COPD. Conclusion Incident ACO is to a large extent determined by factors related to lifestyle and socioeconomic status.
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Affiliation(s)
| | - Zorana Jovanovic Andersen
- Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark, .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,
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9
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Abstract
Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non-Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FENO). As non-Th2-LOA is often resistant to corticosteroids, this phenotype often requires another treatment strategy such as macrolide, diet, or smoking cessation. We often struggle with the management of LOA patients due to a lack of evidence; therefore, the elucidation of the mechanism of LOA contributes to increased efficiency of diagnosis and treatment of LOA. Age-related immune system and structural changes are thought to be associated with the pathophysiology of LOA. In the former case, changes in inflammatory cell function such as variations in the innate immune response and acquisition of autoimmunity or upregulation of oxidative stress are thought to be involved in the mechanism. Meanwhile, the latter can also become triggers or exacerbating factors of LOA via enhancement of airway hyperresponsiveness, decline in lung function, increased air trapping, and reduction in chest wall compliance. Therefore, appropriate individualized management in LOA may be possible through precisely assessing the pathophysiology based on age-related functional changes, including the immune and structural system.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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10
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Baptist AP, Hao W, Karamched KR, Kaur B, Carpenter L, Song PXK. Distinct Asthma Phenotypes Among Older Adults with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:244-249.e2. [PMID: 28757370 PMCID: PMC5897052 DOI: 10.1016/j.jaip.2017.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older adults have high rates of asthma morbidity and mortality. Asthma is now recognized as a heterogeneous disease, yet the distinct phenotypes among older adults are unknown. OBJECTIVE The objective of this study was to identify asthma phenotypes in a diverse population of elderly patients with asthma. METHODS Using cluster analysis, 180 older adults with persistent asthma were analyzed. Subjects completed detailed questionnaires, skin prick testing, and spirometry with reversibility. Twenty-four core variables were analyzed. RESULTS Four groups were identified. Subjects in cluster 1 (n = 69) typically had asthma diagnosed after the age of 40 and the shortest duration of asthma. Cluster 2 (n = 40) had the mildest asthma defined by spirometry, Asthma Control test (ACT), and Asthma Quality of Life Questionnaire (AQLQ). They also had the lowest body mass index (BMI), lowest depression score, and least number of comorbidities. Cluster 3 (n = 46) had the longest duration of asthma (56 years) and the highest atopic skin test sensitization (74%). Cluster 4 (n = 25) had the most severe asthma, with extremely low FEV1% predicted (37.8%), lowest ACT, and lowest AQLQ scores. They were more likely to be black and had the highest comorbidities. Using BMI, posttreatment FEV1% predicted, and duration of asthma, 95.6% of subjects were able to be correctly classified. CONCLUSIONS In older adults with asthma, distinct phenotypes vary on key features that are more pronounced among the elderly, including comorbidities, fixed airway obstruction, and duration of asthma ≥40 years. Further work is required to determine the clinical and therapeutic implications for different asthma phenotypes in older adults.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich.
| | - Wei Hao
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Keerthi R Karamched
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Bani Kaur
- Department of Internal Medicine, Wayne State University, Detroit, Mich
| | - Laurie Carpenter
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Peter X K Song
- Department of Internal Medicine, Wayne State University, Detroit, Mich
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