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Pedersen MK, Bräuner EV, Hansen AH, Hansen LS, Jensen TK, Jørgensen N, Priskorn L. Self-Reported Asthma Is Associated with Reduced Sperm Count-A Cross-Sectional Study of More than 6000 Young Men from the General Population. Life (Basel) 2023; 13:278. [PMID: 36836635 PMCID: PMC9966775 DOI: 10.3390/life13020278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Asthma is driven by an inflammatory response that may impact testicular function. In this cross-sectional study, we investigated the association between self-reported asthma and testicular function (semen parameters, reproductive hormone levels), and determined whether potential further inflammation due to self-reported allergy modified this association. A total of 6177 men from the general population completed a questionnaire including information on doctor-diagnosed asthma or allergy, had a physical examination, delivered a semen sample, and had a blood sample drawn. Multiple linear regression analyses were performed. A total of 656 (10.6%) men reported having ever been diagnosed with asthma. Generally, self-reported asthma was consistently associated with a poorer testicular function; however, few estimates were statistically significant. Specifically, self-reported asthma was associated with statistically significant lower total sperm count [median: 133 vs. 145 million; adjusted β (95% CI): -0.18 (-0.33 to -0.04) million on cubic-root-transformed scale] and borderline statistically significant lower sperm concentration compared with no self-reported asthma. The association between asthma and total sperm count was of similar magnitude among men with and without allergy. In conclusion, men with self-reported asthma had poorer testicular function than men without asthma. However, the cross-sectional design of the study limits ascertainment of causality.
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Affiliation(s)
- Marc K. Pedersen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ann H. Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Laura S. Hansen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Tina K. Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Lærke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
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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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Allergic and non-allergic asthma in children hospitalized in the University Children’s Hospital in Lublin in 2016-2020. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2022. [DOI: 10.2478/cipms-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction. Bronchial asthma is a common disease characterized by chronic inflammation of the airways. Paediatric asthma is still a current problem and children with exacerbation frequently are hospitalized. The aim of the study was to determine the prevalence of allergic and non-allergic asthma in children hospitalized at the Department of Paediatric Pulmonology and Rheumatology of the University Children’s Hospital in Lublin in 2016-2020, and to analyze the most common allergens associated with allergic asthma.
Materials and methods. The study group consisted of 667 patients, aged 6 to 215 months (average 64 months). The data collected for this retrospective study includes: gender, age, month, quarter of year, and year of hospitalization, type of asthma and type of allergens.
Results. We observed a decrease of hospitalization in the analyzed years: in 2016 – 160 children, and in 2020 – 74. Children with allergic asthma (375 children) were more frequently hospitalized than patients with non-allergic asthma, and we found correlations between age and type of asthma and between age and type of allergy. Non-allergic asthma was observed in the youngest children, while in older children, allergic-asthma dominated. We also observed significant differences in children’s hospitalization depending on the season of the year. The most frequent allergen causing asthma was house dust mites.
Conclusions. The incidence of hospitalizations caused by asthma exacerbation is declining. Among the youngest population, exacerbations of asthma related to respiratory tract infection predominate, while in the older, allergy to inhalation allergens is the main cause.
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Asthma and Allergy: Unravelling a Tangled Relationship with a Focus on New Biomarkers and Treatment. Int J Mol Sci 2022; 23:ijms23073881. [PMID: 35409241 PMCID: PMC8999577 DOI: 10.3390/ijms23073881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/19/2022] Open
Abstract
Asthma is a major driver of health care costs across ages. Despite widely disseminated asthma-treatment guidelines and a growing variety of effective therapeutic options, most patients still experience symptoms and/or refractoriness to standard of care treatments. As a result, most patients undergo a further intensification of therapy to optimize symptom control with a subsequent increased risk of side effects. Raising awareness about the relevance of evaluating aeroallergen sensitizations in asthmatic patients is a key step in better informing clinical practice while new molecular tools, such as the component resolved diagnosis, may be of help in refining the relationship between sensitization and therapeutic recommendations. In addition, patient care should benefit from reliable, easy-to-measure and clinically accessible biomarkers that are able to predict outcome and disease monitoring. To attain a personalized asthma management and to guide adequate treatment decisions, it is of paramount importance to expand clinicians' knowledge about the tangled relationship between asthma and allergy from a molecular perspective. Our review explores the relevance of allergen testing along the asthma patient's journey, with a special focus on recurrent wheezing children. Here, we also discuss the unresolved issues regarding currently available biomarkers and summarize the evidence supporting the eosinophil-derived neurotoxin as promising biomarker.
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Pothirat C, Chaiwong W. Aeroallergen Sensitization and Clinical Characteristics of Subjects with Chronic Rhinitis in Chiang Mai, Thailand: A Twenty-Year Retrospective Study. J Asthma Allergy 2021; 14:789-795. [PMID: 34262297 PMCID: PMC8274822 DOI: 10.2147/jaa.s315081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of common aeroallergen sensitization in subjects with AR and clinical comparison between AR and Non-AR (NAR) subjects in Thailand remains limited. The primary objective of this study was to illustrate the prevalence of the common aeroallergen sensitization in AR subjects and the differences in clinical characteristics between AR and NAR subjects. Methods Data were retrospectively collected from all subjects with chronic rhinitis who have visited the Chest and Allergy Clinic in three settings in Chiang Mai, Thailand between January 1998 and December 2018. Clinical characteristics and the result of skin prick test (SPT) to common aeroallergen were collected. Results A total of 2164 subjects with chronic rhinitis were enrolled, SPT was performed in 1001 (46.3%); 655 (65.4%) and 346 (34.6%) were AR and NAR, respectively. Mite mixed was the most frequent aeroallergen sensitization in subjects with AR both without asthma and with asthma (86.4% and 85.6%) followed by cockroach mixed (54.4% and 58.9%), grass pollen (38.9% and 40.4%), animal dander (15.5% and 19.9%), and mold mixed (5.7% and 11.0%). Polysensitization was higher in younger adults compared to middle aged adult and older adult (72.5%, 67.4%, and 58.7%, respectively, p=0.041). The AR subjects had lower age, earlier age of disease onset, and longer duration of disease (32.6±16.3 vs 40.2±15.4 years, 24 (10–36) vs 34 years (22–45), 3 (1–10) vs 2 years (0–5), respectively, p<0.001). The AR subjects also had more asthma, conjunctivitis, and family history of chronic rhinitis (22.3% vs 15.6%, 25.3% vs 4.3%, and 58.0% vs 43.3%, respectively, p<0.05). Conclusion The most common aeroallergen for AR (with and without asthma) was mite mixed followed by cockroach mixed and grass pollen. Polysensitization was significant higher in younger adult than middle aged and older adult. AR was significantly associated with asthma, conjunctivitis and family history of chronic rhinitis compared to NAR.
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Affiliation(s)
- Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Li Z, Yu M, Wang P, Qian H, Fan Y, Li X, Xu Q, Wang X, Wang X, Lu C. Association between maternal diabetes mellitus and allergic diseases in children - A systematic review and meta-analysis. Pediatr Allergy Immunol 2021; 32:880-891. [PMID: 33709502 DOI: 10.1111/pai.13498] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Existing knowledge suggests that gestational diabetes mellitus was inconsistently associated with offspring allergic diseases. The aim of this study was to identify the association between maternal diabetes mellitus and the risk of offspring allergic diseases by systematic review. METHODS We searched and retrieved three databases (PubMed, Web of Science, and Cochrane Library) for articles on the association between maternal diabetes mellitus and offspring allergic diseases published before December 31, 2019. Stata software version 16.0 was used for statistical analysis. RESULTS Eight published studies were included in this meta-analysis. The pooled effect estimates showed the association between maternal diabetes mellitus and allergic outcomes, including asthma (OR: 1.13, 95% CI: 1.01-1.27), wheezing (OR: 1.13, 95% CI: 1.07-1.21), and atopic dermatitis (OR: 1.43, 95% CI: 1.22-1.57). Maternal diabetes mellitus was not associated with the risk of allergic sensitization, with a pooled effect estimate of 1.07 (95% CI: 0.45, 2.58). CONCLUSION Maternal diabetes mellitus may increase the risk of allergic diseases in their children. However, this finding should be validated with future large-sample epidemiological studies covering a wider spectrum of allergic diseases.
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Affiliation(s)
- Zhi Li
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mei Yu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Pin Wang
- Department of Gastroenterology, Nanjing Drum tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hong Qian
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yun Fan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiuzhu Li
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiaoqiao Xu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Chuncheng Lu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
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Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease. Epidemiology 2021; 31:459-466. [PMID: 32028323 DOI: 10.1097/ede.0000000000001176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various questionnaire-based definitions of chronic obstructive pulmonary disease (COPD) have been applied using the US representative National Health and Nutrition Examination Survey (NHANES), but few have been validated against objective lung function data. We validated two prior definitions that incorporated self-reported physician diagnosis, respiratory symptoms, and/or smoking. We also validated a new definition that we developed empirically using gradient boosting, an ensemble machine learning method. METHODS Data came from 7,996 individuals 40-79 years who participated in NHANES 2007-2012 and underwent spirometry. We considered participants "true" COPD cases if their ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity was below 0.7 or the lower limit of normal. We stratified all analyses by smoking history. We developed a gradient boosting model for smokers only; predictors assessed (25 total) included sociodemographics, inhalant exposures, clinical variables, and respiratory symptoms. RESULTS The spirometry-based COPD prevalence was 26% for smokers and 8% for never smokers. Among smokers, using questionnaire-based definitions resulted in a COPD prevalence ranging from 11% to 16%, sensitivity ranging from 18% to 35%, and specificity ranging from 88% to 92%. The new definition classified participants based on age, bronchodilator use, body mass index (BMI), smoking pack-years, and occupational organic dust exposure, and resulted in the highest sensitivity (35%) and specificity (92%) among smokers. Among never smokers, the COPD prevalence ranged from 4% to 5%, and we attained good specificity (96%) at the expense of sensitivity (9-10%). CONCLUSION Our results can be used to parametrize misclassification assumptions for quantitative bias analysis when pulmonary function data are unavailable.
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Quirce S, Heffler E, Nenasheva N, Demoly P, Menzies-Gow A, Moreira-Jorge A, Nissen F, Hanania NA. Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy. J Asthma Allergy 2020; 13:743-752. [PMID: 33408487 PMCID: PMC7781019 DOI: 10.2147/jaa.s282205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particularly women, present with asthma for the first time in adult life, tend to be non-allergic and often require higher doses of inhaled corticosteroids (ICS) or are relatively refractory to corticosteroid treatment. In this review, we examine the published literature improve the understanding of the following aspects of LOA: 1) the age cut-off for its diagnosis; 2) its distinct clinical phenotypes, characteristics and risk factors; and 3) its association with allergic comorbidities and conditions. Overall, our review reveals that clinicians and researchers have used multiple age cut-offs to define LOA, with cut-off ages ranging from >12 years to ≥65 years. LOA has also been classified into several distinct phenotypes, some of which drastically differ in their clinical characteristics, course and prognosis. Although LOA has traditionally been considered non-allergic in nature, our review indicates that it is commonly associated with allergic features and comorbidities. Our findings suggest that there is an urgent need for the development of more clear clinical practice guidelines that can provide more clarity on the definition and other aspects of LOA. In addition, the association of LOA and allergy needs to be re-examined to frame a more optimal treatment strategy for patients with LOA.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Natalia Nenasheva
- Department of Allergology and Immunology of Russian Medical Academy for Continuous Medical Education, Moscow, Russian Federation
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | | | - Francis Nissen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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Nieto‐Fontarigo JJ, González‐Barcala FJ, Andrade‐Bulos LJ, San‐José ME, Cruz MJ, Valdés‐Cuadrado L, Crujeiras RM, Arias P, Salgado FJ. iTRAQ-based proteomic analysis reveals potential serum biomarkers of allergic and nonallergic asthma. Allergy 2020; 75:3171-3183. [PMID: 32424932 DOI: 10.1111/all.14406] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/16/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Asthma is heterogeneous disease with different phenotypes, endotypes and severities. Definition of these subgroups requires the identification of biomarkers in biological samples, and serum proteomics is a useful and minimally invasive method for this purpose. Therefore, the aim of this study was to detect serum proteins whose abundance is distinctively associated with different asthma phenotypes (allergic vs nonallergic) or severities. METHODS For each group of donors (32 healthy controls, 43 allergic rhinitis patients and 192 asthmatics with different phenotypes and severities), we generated two pools of sera that were analysed by a shotgun MS approach based on combinatorial peptide ligand libraries and iTRAQ-LC-MS/MS. RESULTS MS analyses identified 18 proteins with a differential abundance. Functional/network study of these proteins identified key processes for asthma pathogenesis, such as complement activation, extracellular matrix organization, platelet activation and degranulation, or post-translational protein phosphorylation. Furthermore, our results highlighted an enrichment of the "Regulation of Insulin-like Growth Factor (IGF) transport and uptake by Insulin-like Growth Factor Binding Proteins (IGFBPs)" route in allergic asthma and the lectin pathway of complement activation in nonallergic asthma. Thus, several proteins (eg IGFALS, HSPG2, FCN2 or MASP1) displayed a differential abundance between the different groups of donors. Particularly, our results revealed IGFALS as a useful biomarker for moderate-severe allergic asthma. CONCLUSION Our data suggest a set of serum biomarkers, especially IGFALS, capable of differentiating allergic from nonallergic asthma. These proteins reveal different pathophysiological mechanisms and may be useful in the future for diagnosis, prognosis or targeted therapy purposes.
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Affiliation(s)
- Juan José Nieto‐Fontarigo
- Department of Biochemistry and Molecular Biology Faculty of Biology‐Biological Research Centre (CIBUS) Universidade de Santiago de Compostela Santiago de Compostela Spain
| | - Francisco Javier González‐Barcala
- Department of Medicine Universidade de Santiago de Compostela Santiago de Compostela Spain
- Department of Respiratory Medicine University Hospital of Santiago de Compostela Santiago de Compostela Spain
- Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
- Spanish Biomedical Research Networking Centre‐CIBERES Madrid Spain
| | - Luis Juan Andrade‐Bulos
- Department of Biochemistry and Molecular Biology Faculty of Biology‐Biological Research Centre (CIBUS) Universidade de Santiago de Compostela Santiago de Compostela Spain
| | - María Esther San‐José
- Clinical Analysis Service University Hospital of Santiago de Compostela Santiago de Compostela Spain
| | - María Jesús Cruz
- Spanish Biomedical Research Networking Centre‐CIBERES Madrid Spain
- Department of Respiratory Medicine‐Hospital Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - Luis Valdés‐Cuadrado
- Department of Medicine Universidade de Santiago de Compostela Santiago de Compostela Spain
- Department of Respiratory Medicine University Hospital of Santiago de Compostela Santiago de Compostela Spain
- Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Rosa María Crujeiras
- Department of Statistics, Mathematical Analysis and Optimization Universidade de Santiago de Compostela Santiago de Compostela Spain
| | - Pilar Arias
- Department of Biochemistry and Molecular Biology Faculty of Biology‐Biological Research Centre (CIBUS) Universidade de Santiago de Compostela Santiago de Compostela Spain
| | - Francisco Javier Salgado
- Department of Biochemistry and Molecular Biology Faculty of Biology‐Biological Research Centre (CIBUS) Universidade de Santiago de Compostela Santiago de Compostela Spain
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Age-specific incidence of allergic and non-allergic asthma. BMC Pulm Med 2020; 20:9. [PMID: 31924190 PMCID: PMC6954552 DOI: 10.1186/s12890-019-1040-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 12/23/2019] [Indexed: 11/20/2022] Open
Abstract
Background Onset of allergic asthma has a strong association with childhood but only a few studies have analyzed incidence of asthma from childhood to late adulthood in relation to allergy. The purpose of the study was to assess age-specific incidence of allergic and non-allergic asthma. Methods Questionnaires were sent to 8000 randomly selected recipients aged 20–69 years in Finland in 2016. The response rate was 52.3% (n = 4173). The questionnaire included questions on e.g. atopic status, asthma and age at asthma diagnosis. Asthma was classified allergic if also a physician-diagnosed allergic rhinitis was reported. Results The prevalence of physician-diagnosed asthma and allergic rhinitis were 11.2 and 17.8%, respectively. Of the 445 responders with physician-diagnosed asthma, 52% were classified as allergic and 48% as non-allergic. Median ages at diagnosis of allergic and non-allergic asthma were 19 and 35 years, respectively. Among subjects with asthma diagnosis at ages 0–9, 10–19, 20–29, 30–39, 40–49, 50–59 and 60–69 years, 70, 62, 58, 53, 38, 19 and 33%, respectively, were allergic. For non-allergic asthma, the incidence rate was lowest in children and young adults (0.7/1000/year). It increased after middle age and was highest in older age groups (2.4/1000/year in 50–59 years old). Conclusions The incidence of allergic asthma is highest in early childhood and steadily decreases with advancing age, while the incidence of non-allergic asthma is low until it peaks in late adulthood. After approximately 40 years of age, most of the new cases of asthma are non-allergic.
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Polivka BJ, Folz R, Myers J, Barnett R, Antimisiaris D, Jorayeva A, Beatty B. Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results. Res Nurs Health 2019; 41:336-345. [PMID: 30357896 DOI: 10.1002/nur.21880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/22/2018] [Indexed: 01/05/2023]
Abstract
Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are ≥60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.
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Affiliation(s)
| | - Rodney Folz
- Case Western Reserve University and University Hospital, Cleveland, Ohio
| | - John Myers
- Department of Pediatrics, University of Louisville School, Louisville, Kentucky
| | | | - Demetra Antimisiaris
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Anna Jorayeva
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Bryan Beatty
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
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Rojano B, West E, Ferdermann E, Markowitz S, Harrison D, Crowley L, Busse P, Federman AD, Wisnivesky JP. Allergen Sensitization and Asthma Outcomes among World Trade Center Rescue and Recovery Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050737. [PMID: 30823641 PMCID: PMC6427816 DOI: 10.3390/ijerph16050737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 01/01/2023]
Abstract
A large number of World Trade Center (WTC) rescue and recovery workers are affected by asthma. While physical and mental health comorbidities have been associated with poor asthma control in this population, the potential role of allergen sensitization is unknown. This study examined the association of indoor sensitization and exposure as a risk factor for increased asthma morbidity in WTC workers. We used data from a prospective cohort of 331 WTC workers with asthma. Sensitization to indoor allergens was assessed by measurement of antigen-specific serum immunoglobulin E (IgE) levels. We used validated tools to evaluate the exposure to indoor allergens. Asthma morbidity outcomes included level of control (Asthma Control Questionnaire, ACQ), quality of life (Asthma Quality of Life Questionnaire, AQLQ) and acute resource utilization. The prevalence of sensitization to cat, dog, mouse, dust mite, cockroach, and mold allergens were 33%, 21%, 17%, 40%, 17%, and 17%, respectively. Unadjusted and regression analyses showed no significant relationship between sensitization and increased asthma morbidity (p > 0.05 for all comparisons), except for sensitization to Aspergillus Fumigatus, cat and mouse epithelium, which were associated with decreased morbidity.
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Affiliation(s)
- Belen Rojano
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Erin West
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Emily Ferdermann
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Steven Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, New York, NY 11367, USA.
| | - Denise Harrison
- Department of Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY 10016, USA.
| | - Laura Crowley
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Paula Busse
- Division of Allergy and Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Alex D Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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13
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Yu J, Tang Y, Xu J. Effects of indoor coal fine particulate matter on the expression levels of inflammatory factors in ovalbumin-induced mice. Toxicol Res (Camb) 2019; 8:57-66. [PMID: 30713661 PMCID: PMC6334494 DOI: 10.1039/c8tx00221e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: Cooking and heating with coal is the main source of household air pollution in acid rain-plagued areas of China and is a leading contributor to disease burden. In this study, we investigated the adverse effects of exposure to indoor fine particulate matter emission from coal combustion on the expression levels of inflammatory factors in ovalbumin (OVA)-induced mice. Methods: Forty BALB/c male mice were randomly divided into four groups (control group, PM2.5 group, OVA group, and OVA + PM2.5 group; n = 10) and treated with ovalbumin (OVA) or PM2.5, alone or together. Interleukin-4 (IL-4), interleukin-7 (IL-7), interleukin-8 (IL-8), interleukin-17 (IL-17), transforming growth factor β1 (TGF-β1), and interferon γ (IFN-γ) protein expression levels were measured in bronchoalveolar lavage fluid (BALF). Additionally, serum immunoglobulin (Ig) IgE and IgG1 levels were measured. The mRNA expression levels of IL-7 and IFN-γ in pulmonary tissue were also analyzed. Bronchoalveolar lavage (BAL), inflammatory cell counts, and histopathological examinations were also performed. Results: Exposure to PM2.5 + OVA induced abnormal pathological changes and inflammatory responses in lungs compared to the control. The levels of IL-4, IL-7, IL-8 and IL-17 in BALF from the OVA + PM2.5 group were higher than those in BALF from the control group, OVA group, and PM2.5 group (P < 0.05). PM2.5 plus OVA significantly raised the serum IgE and IgG1 levels compared with the control group. An increasing IL-7 mRNA trend was found among the treatment groups (P < 0.05). The expression level of IFN-γ mRNA was significantly higher in the control group than in the other 3 groups (P < 0.05). Conclusion: Indoor coal PM2.5 was sufficient by itself to cause inflammatory cellular infiltration of pulmonary tissue, leading to organelle injury and physiological structure change. Additionally, it promoted the occurrence and development of asthma by influencing the expression levels of IL-7 and various relevant inflammatory factors (such as IL-4 and IL-8) and changing the equilibrium between Treg and Th17 cells.
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Affiliation(s)
- Jie Yu
- School of Public Health , Zunyi Medical University , Zunyi , Guizhou 563099 , P.R. China . ; Tel: +86851-28642732
| | - Yin Tang
- School of Public Health , Zunyi Medical University , Zunyi , Guizhou 563099 , P.R. China . ; Tel: +86851-28642732
| | - Jie Xu
- School of Public Health , Zunyi Medical University , Zunyi , Guizhou 563099 , P.R. China . ; Tel: +86851-28642732
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14
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Yáñez A, Soria M, De Barayazarra S, Recuero N, Rovira F, Jares E, Stok AM, Nemirovsky S, Bueno C. Clinical characteristics and comorbidities of elderly asthmatics who attend allergy clinics. Asthma Res Pract 2018; 4:5. [PMID: 29713490 PMCID: PMC5911961 DOI: 10.1186/s40733-018-0041-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background To date, few studies have focused on the clinical and allergic characteristics of asthma in the elderly, defined as asthma in people aged 60 or over. Thus, we propose to identify and study the clinical and allergic characteristics and comorbidities of patients with asthma among the elderly. Methods A retrospective, observational, descriptive study was developed in five clinics and hospitals in Argentina. Allergy Physicians analyzed their patients' medical records in 2014 and included those adults over the age of 60, who had been diagnosed with asthma according to the GINA guidelines. Clinical and allergic characteristics were analyzed. Results A total of 152 patients diagnosed with asthma, of whom 73% were women and 11% ex-smokers, were included in this study, with a mean age of 66 years. Only 10.5% of the participants had onset asthma past the age of 60. Regarding asthma severity, 74.3% were diagnosed with moderate persistent asthma, and 7.2% with severe persistent asthma. Eighty-four percent of the patients were treated with an inhaled corticosteroid (ICS) along with a long-acting β 2-adrenergic agent (LABA). More than half of the patients had two or more comorbidities simultaneously. Allergic comorbidities were the most frequent comorbidities, followed by arterial hypertension. Among allergic comorbidities, most patients presented allergies at the nasal level. There were no significant differences between the subpopulations of patients with late-onset asthma (LOA) and asthma with onset before the age of 60, i.e. early onset asthma (EOA) in most of their clinical characteristics. However, it was observed that EOA accounted for a higher percentage of patients with nasal allergies as compared to LOA (71% vs 46%, p < 0.05).It is worth mentioning that almost half of the patients with LOA had allergies at the nasal level. Conclusion These results may provide a better understanding of the clinical characteristics of asthma in the elderly in Argentina, thus, enabling the development of future therapeutic strategies and a better quality of life for our elderly asthma patients.
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Affiliation(s)
- Anahí Yáñez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | - Marcela Soria
- Hospital Zona General de Agudos Dr. Ricardo Gutiérrez, La Plata, Argentina
| | | | - Nancy Recuero
- Allergy and Immunology Service, Hospital San Roque, Córdoba, Argentina
| | - Francisco Rovira
- Argentine Respiratory Medicine Association, Buenos Aires, Argentina
| | - Edgardo Jares
- Private Medical Centers SA, Ramos Mejía, Buenos Aires Argentina
| | - Ana María Stok
- Instituto de Investigaciones en Patologías Respiratorias, San Miguel de Tucumán, Tucumán Argentina
| | - Sergio Nemirovsky
- 7CONICET - Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - Carlos Bueno
- 7CONICET - Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina.,8Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Universidad de Buenos Aires, Laboratorio de Virología, Buenos Aires, Argentina
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15
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Dunn RM, Busse PJ, Wechsler ME. Asthma in the elderly and late-onset adult asthma. Allergy 2018; 73:284-294. [PMID: 28722758 DOI: 10.1111/all.13258] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/26/2022]
Abstract
Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related physiologic and immunologic changes that complicate the presentation, diagnosis, and management of asthma in the aged population. Evidence suggests that elderly asthmatics are more likely to be underdiagnosed and undertreated. Additionally, elderly patients with asthma have highest rates of morbidity and mortality from their disease than younger patients. The underlying airway inflammation of asthma in this age group likely differs from younger patients and is felt to be non-type 2 mediated. While elderly patients are underrepresented in clinical trials, subgroup analysis of large clinical trials suggests they may be less likely to respond to traditional asthma therapies (ie, corticosteroids). As the armamentarium of pharmacologic asthma therapies expands, it will be critical to include elderly asthmatics in large clinical trials so that therapy may be better tailored to this at-risk and growing population.
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Affiliation(s)
- R. M. Dunn
- Department of Pulmonary and Critical Care Medicine; University of Colorado School of Medicine; Aurora CO USA
- National Jewish Health; Denver CO USA
| | - P. J. Busse
- Division of Clinical Immunology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. E. Wechsler
- Department of Pulmonary and Critical Care Medicine; National Jewish Health; Denver CO USA
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16
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Di Lorenzo G, Di Bona D, Belluzzo F, Macchia L. Immunological and non-immunological mechanisms of allergic diseases in the elderly: biological and clinical characteristics. IMMUNITY & AGEING 2017; 14:23. [PMID: 29296117 PMCID: PMC5738884 DOI: 10.1186/s12979-017-0105-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/07/2017] [Indexed: 02/08/2023]
Abstract
A better hygiene, a Westernized diet, air pollution, climate changes, and other factors that influence host microbiota, a key player in the induction and maintenance of immunoregulatory circuits and tolerance, are thought to be responsible for the increase of allergic diseases observed in the last years. The increase of allergic diseases in elderly is related to the presence of other factors as several comorbidities that should interfere with the development and the type of allergic reactions. A central role is played by immunosenescence responsible for modifying response to microbiota and triggering inflamm-ageing. In addition, in elderly there is a shift from Th1 responses vs. Th2, hence favouring allergic responses. Better understanding of the mechanisms of immunosenescence and its effects on allergic inflammation will most certainly lead to improved therapy.
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Affiliation(s)
- Gabriele Di Lorenzo
- Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy.,Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Via del Vespro, 141, 90127 Palermo, Italy
| | - Danilo Di Bona
- Department of Allergy, Clinical Immunology, Emergency Medicine, and Transplants, University of Bari, Bari, Italy
| | - Federica Belluzzo
- Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy
| | - Luigi Macchia
- Department of Allergy, Clinical Immunology, Emergency Medicine, and Transplants, University of Bari, Bari, Italy
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17
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Agondi RC, Andrade MC, Takejima P, Aun MV, Kalil J, Giavina-Bianchi P. Atopy Is Associated with Age at Asthma Onset in Elderly Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:865-871. [PMID: 29175370 DOI: 10.1016/j.jaip.2017.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/08/2017] [Accepted: 10/25/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Asthma in the elderly population (60 years of age and older) is frequently underdiagnosed, as well as atopy. Atopy, although more prevalent in younger patients, can be a major cause of asthma in the elderly. Chronic obstructive pulmonary disease (COPD) and cardiovascular disease are common differential diagnoses, especially in elderly smokers. OBJECTIVE The objective of this study was to assess atopy and comorbidities in elderly patients with asthma. METHODS This was an observational and retrospective study involving elderly asthmatic patients followed up at a tertiary center. Patients were assessed for severity of asthma, frequency of atopy, and frequency of comorbidities concomitant with asthma. Then, they were classified according to their age at asthma onset and the groups compared with each other for atopy, spirometric parameters, and comorbidities. RESULTS This study included 243 elderly asthmatic patients, 71.8% of them presenting severe disease and 82.3% forced expiratory volume in 1 second (FEV1) < 80%. Gastroesophageal reflux disease, obesity, and asthma-COPD overlap syndrome were observed, respectively, in 64%, 37%, and 13% of these patients. Atopy was observed in 63%, mainly in those with early onset disease, and its frequency decreased as the age of asthma onset increased (P < .05). Total serum IgE was higher for allergic patients and FEV1 values were lower for patients with long-term asthma. Aspirin-exacerbated respiratory disease was more frequent in patients with nonallergic asthma. CONCLUSIONS Most elderly asthmatic patients followed up in our tertiary center were atopic and higher values of total serum IgE suggest atopy. Atopy was inversely correlated with age of asthma onset. The diagnosis of allergic asthma in the elderly population is essential to treat patients more properly, improving their quality of life and decreasing asthma morbidity and mortality.
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Affiliation(s)
- Rosana Câmara Agondi
- Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Mayra Coutinho Andrade
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Priscila Takejima
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcelo Vivolo Aun
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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18
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Ferreira DS, Kaushik S, Smith CL, Dharmage SC, Benke GP, Thompson BR, Walters EH, Wolfe R, Abramson MJ. Associations of atopy and asthma during aging of an adult population over a 20-year follow-up. J Asthma 2017; 55:994-1001. [PMID: 28976229 DOI: 10.1080/02770903.2017.1386669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Atopy is associated with asthma, but cross-sectional studies suggest this association may be weaker in older adults. It remains unclear if atopy predicts asthma later in adult life. We aimed to investigate whether atopy in young adults predicted asthma 20 years later and to quantify the contemporaneous relationship of atopy and asthma as adults age. METHODS Participants of the European Community Respiratory Health Survey (ECRHS) in Melbourne aged 20-44 years were followed for 20 years and completed questionnaires, skin prick tests (SPT) and allergen specific immunoglobulin E measurement at a baseline and two subsequent surveys. Using logistic regression and generalized estimating equations, we tested if atopy at baseline predicted current asthma later in life and estimated the association between current atopy measured at each survey and current asthma, while adjusting for potential confounders. RESULTS The analysis included 220 participants: 50.9% male. Mean (SD) age at baseline was 35.7 (5.7) years. Asthma and atopy prevalence remained stable over 20 years. Baseline atopy (SPT) was associated with current asthma (OR 9.74, 95%CI 4.22, 22.5) over 20 years, and current atopy (SPT) with concurrent asthma (3.12; 1.70, 5.74). CONCLUSIONS Atopy remains strongly associated with current asthma in 40 to 64 year-old adults, both prospectively and contemporaneously, but the prospective association is stronger.
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Affiliation(s)
- Diogenes S Ferreira
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Sonia Kaushik
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Catherine L Smith
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Shyamali C Dharmage
- b Allergy & Lung Health Unit , Melbourne School of Global & Population Health , Melbourne , Australia
| | - Geza P Benke
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Bruce R Thompson
- c Allergy, Immunology & Respiratory Medicine, The Alfred , Melbourne , Australia
| | - E Haydn Walters
- d University of Tasmania , Tasmania 7005 , Australia.,e University of Notre Dame , Victoria 3030 , Australia
| | - Rory Wolfe
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Michael J Abramson
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
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19
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Depression and Asthma Outcomes in Older Adults: Results from the National Health and Nutrition Examination Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017. [DOI: 10.1016/j.jaip.2017.03.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Toppila‐Salmi S, Luukkainen A, Lemmetyinen R, Karjalainen J, Huhtala H, Renkonen R, Wang DY, Mäkelä MJ, Pekkanen J. Birth decade affects the sensitization pattern and asthma risk in Finnish adult population. Allergy 2017; 72:1791-1795. [PMID: 28444953 DOI: 10.1111/all.13194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2017] [Indexed: 11/26/2022]
Abstract
We have previously shown that sensitizations to several types of allergens distinguish subjects with and without adult-onset asthma in Finland. The aim was to analyze how age affects sensitization and asthma risk. We used previous population-based case-control data (N=456) from Finnish adult asthma patients with one or two matched controls. Asthma was diagnosed based on a typical history of asthmatic symptoms and lung function tests. Allergic sensitization was determined by skin prick test (SPT) to 17 aeroallergens. Information on demographics was obtained by a questionnaire. Sensitization to more than one allergen type and the number of positive SPT reactions associated with younger age and asthma. Atopic subjects aged 65 and above were characterized by sensitization to only one to two allergens, with very few animal danders and without an association with asthma. Multiple sensitizations and animal dander sensitization are more common among Finnish asthmatic adults aged under 56 than among older asthmatics. Cohort studies are needed to understand timing of host-environmental interactions behind this.
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Affiliation(s)
- S. Toppila‐Salmi
- Haartman Institute University of Helsinki Helsinki Finland
- Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - A. Luukkainen
- Haartman Institute University of Helsinki Helsinki Finland
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - R. Lemmetyinen
- Haartman Institute University of Helsinki Helsinki Finland
| | - J. Karjalainen
- Allergy Centre Tampere University Hospital Tampere Finland
| | - H. Huhtala
- Faculty of Social Sciences University of Tampere Tampere Finland
| | - R. Renkonen
- Haartman Institute University of Helsinki Helsinki Finland
- HUSLAB Helsinki University Hospital Helsinki Finland
| | - D. Y. Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - M. J. Mäkelä
- Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - J. Pekkanen
- Department of Public Health University of Helsinki Helsinki Finland
- Department of Health Protection National Institute for Health and Welfare Kuopio Finland
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21
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Caillaud D, Chanez P, Escamilla R, Burgel PR, Court-Fortune I, Nesme-Meyer P, Deslee G, Perez T, Paillasseur JL, Pinet C, Jebrak G, Roche N. Asthma-COPD overlap syndrome (ACOS) vs 'pure' COPD: a distinct phenotype? Allergy 2017; 72:137-145. [PMID: 27501862 DOI: 10.1111/all.13004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Some studies suggest that asthma-COPD overlap syndrome (ACOS) is associated with worse outcomes than chronic obstructive pulmonary disease (COPD). The goal of this study was to further explore the clinical characteristics and survival of patients with ACOS identified in a real-life cohort of patients with COPD. METHODS Data from the French COPD cohort 'INITIATIVES BronchoPneumopathie Chronique Obstructive' (n = 998 patients) were analyzed to assess the frequency of ACOS defined as a physician diagnosis of asthma before the age of 40 years and to analyze its impact. Univariate analyses were performed to assess the relationship between ACOS and sociodemographic characteristics, risk factors (smoking, occupational exposure, atopic diseases), symptoms (chronic bronchitis, dyspnea-modified Medical Research Council scale and baseline dyspnea index), quality of life (QoL), mood disorders, exacerbations, comorbidities, lung function, prescribed treatment, and survival. RESULTS ACOS was diagnosed in 129 patients (13%). In multivariate analyses, ACOS was associated negatively with cumulative smoking (odds ratio [OR]: 0.992; 95% CI 0.984-1.000 per pack-year) and positively with obesity: OR: 1.97 [1.22-3.16], history of atopic disease (hay fever: OR: 5.50 [3.42-9.00] and atopic dermatitis: OR 3.76 [2.14-6.61]), and drug use (LABA + ICS: 1.86 [1.27-2.74], antileukotrienes 4.83 [1.63-14.34], theophylline: 2.46 [1.23-4.91], and oral corticosteroids: [2.99;.1.26-7.08]). No independent association was found with dyspnea, QoL, exacerbations, and mortality. CONCLUSIONS Compared to 'pure' COPD patients, patients with ACOS exhibit lower cumulative smoking, suffer more from obesity and atopic diseases, and use more asthma treatments. Disease severity (dyspnea, QoL, exacerbations, comorbidities) and prognosis (mortality) are not different from 'pure' COPD patients.
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Affiliation(s)
- D. Caillaud
- Pulmonary Department; Gabriel Montpied University Hospital; Auvergne University; Clermont-Ferrand France
| | - P. Chanez
- Pulmonary Department; APHM; INSERM U1077; CNRS UMR 7733 Aix Marseille Université; Marseille France
| | - R. Escamilla
- Pulmonary Department; Larrey University Hospital; Toulouse France
| | - P-R. Burgel
- Respiratory and Intensive Care Medicine; Cochin Hospital; AP-HP and Paris Descartes University; Sorbonne Paris Cité; Paris France
| | | | - P. Nesme-Meyer
- Pulmonary Department; La Croix Rousse University Hospital; Lyon France
| | - G. Deslee
- Pulmonary Department; Maison Blanche University Hospital; INSERM U903; Reims France
| | - T. Perez
- Clinique des Maladies Respiratoires; Albert Calmette University Hospital; Lille France
| | | | - C. Pinet
- Polyclinique Les Fleurs; Pneumologie; Ollioules France
| | - G. Jebrak
- Pulmonary Department; Bichat Hospital; AP-HP; Paris France
| | - N. Roche
- Respiratory and Intensive Care Medicine; Cochin Hospital; AP-HP and Paris Descartes University; Sorbonne Paris Cité; Paris France
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22
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Meng Q, Nagarajan S, Son Y, Koutsoupias P, Bielory L. Asthma, oculonasal symptoms, and skin test sensitivity across National Health and Nutrition Examination Surveys. Ann Allergy Asthma Immunol 2016; 116:118-125.e5. [PMID: 26815704 DOI: 10.1016/j.anai.2015.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/14/2015] [Accepted: 11/07/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The increasing prevalence of allergies and asthma has been reported. However, the progression of the prevalence of allergy (the "allergic diathesis progression") has not been examined over time from skin test positivity to oculonasal symptoms to the development of asthma. OBJECTIVE To investigate the change in the prevalences and associations of positive skin test reactions, oculonasal symptoms, and asthma during the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III, respectively). METHODS Data collected during NHANES II and III were used. The prevalence and associations of positive skin test reactions, oculonasal symptoms, and asthma and the linear trend of oculonasal symptoms and asthma prevalence across different cumulative positive skin test reactions were calculated for each NHANES period. RESULTS From NHANES II to NHANES III, the prevalence of asthma doubled (2 times) and increased for positive skin test reactions (2.2 times), oculonasal symptoms (3.3 times), and concurrence of asthma, oculonasal symptoms, and positive skin test reactions (5.3 times). People were sensitive to an increasing number of allergens. Positive skin test reactions increased from 0.2% (NHANES II) to 2.7% (NHANES III) for people allergic to all 6 allergens. CONCLUSION Despite some methodologic differences in skin tests across NHANES II and III, this study demonstrated significant increases in allergen sensitivities (prevalence and number of allergens), oculonasal symptoms, and asthma over a 20-year course, indicating that increased sensitivity led to increased allergic symptoms and asthma during the 20 years from NHANES II to NHANES III.
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Affiliation(s)
- Qingyu Meng
- School of Public Health, Rutgers University, Piscataway, New Jersey.
| | | | - Yeongkwon Son
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | | | - Leonard Bielory
- Rutgers University Center for Environmental Prediction, New Brunswick, New Jersey; STARx Allergy and Asthma Center, Springfield, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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23
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Ozturk AB, Iliaz S. Challenges in the management of severe allergic asthma in the elderly. J Asthma Allergy 2016; 9:55-63. [PMID: 27051308 PMCID: PMC4803249 DOI: 10.2147/jaa.s85420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Little is known about the features of asthma and allergy in the elderly. A significant number of elderly patients with asthma have uncontrolled and severe asthma. This review aims to provide an analysis of the literature on the assessment and phenotype of severe allergic asthma in the elderly. Gaps and pitfalls in diagnostic and therapeutic approaches, as well as management of severe allergic asthma in the elderly, are also discussed.
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Affiliation(s)
- Ayse Bilge Ozturk
- Department of Allergy and Immunology, Koç University Hospital, Istanbul, Turkey
| | - Sinem Iliaz
- Department of Pulmonary Medicine, Koç University Hospital, Istanbul, Turkey
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Ozturk AB, Ozyigit Pur L, Kostek O, Keskin H. Association between asthma self-management knowledge and asthma control in the elderly. Ann Allergy Asthma Immunol 2015; 114:480-4. [PMID: 25935432 DOI: 10.1016/j.anai.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/31/2015] [Accepted: 04/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Considerable evidence points to the importance of patient education in achieving better asthma control. However, little is known about the effect of older adults' asthma knowledge on asthma control. OBJECTIVE To identify the relation between asthma self-management knowledge and short-term asthma control in older adults. METHODS The study included 82 patients with asthma undergoing usual asthma care who were interviewed by the same trained allergist. At the same time, the authors conducted an asthma knowledge questionnaire, an Asthma Control Test, skin prick testing, spirometry, and evaluation of inhaler device technique. The Turkish version of the asthma knowledge questionnaire was administered to all participants in face-to-face interviews. The relation between asthma knowledge and asthma control was tested by regression analysis. RESULTS The education level was below the secondary level in 79% of patients; 59% of patients were obese; and 44% of patients had mild, 41% had moderate, and 5% had severe persistent asthma. The atopy rate was 21%. The most common sensitization was to Dermatophagoides pteronyssinus. Fifty-two percent of patients had uncontrolled asthma; 22 patients showed proper use of the inhaler device. Forty patients (48%) had limited asthma knowledge. The main source of asthma knowledge was from physicians for 81% of patients. There was no significant association between patients' asthma knowledge and asthma control level (P = .991). CONCLUSION Knowledge of asthma was very low in elderly patients and usual asthma care was largely insufficient. These findings suggest that asthma education programs should be developed for older adults based on their education level and clinical asthma characteristics.
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Affiliation(s)
- A B Ozturk
- Department of Allergy and Immunology, Koç University, School of Medicine, Istanbul, Turkey.
| | - L Ozyigit Pur
- Department of Allergy and Immunology, Koç University, School of Medicine, Istanbul, Turkey
| | - O Kostek
- Department of Internal Medicine, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - H Keskin
- Department of Internal Medicine, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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Columbo M, Panettieri RA, Rohr AS. Asthma in the elderly: a study of the role of vitamin D. Allergy Asthma Clin Immunol 2014; 10:48. [PMID: 25221606 PMCID: PMC4162927 DOI: 10.1186/1710-1492-10-48] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Asthma in the elderly is poorly understood and vitamin D deficiency and insufficiency are very common in older individuals. We studied the role of vitamin D in elderly asthmatics. Methods Asthmatics subjects, age 65 and older, were followed every 4 weeks for 12 weeks in the late fall and winter. During the study period they took 2,000 I.U. vitamin D3 daily. Serum 25-Hydroxyvitamin D and calcium were measured at baseline and study end. Results Twenty nine percent of subjects were deficient and 50% insufficient in serum vitamin D at baseline. Serum vitamin D increased from 24.3±9.2 ng/ml (60.7±23 nmol/L) to 34±7.1 ng/ml (84.9±17.7 nmol/L) at the end of the study (p<0.001), whereas calcium was unchanged. We found no significant association between vitamin D and subjects' demographics. Vitamin D was similar in men and women. There was no association between serum vitamin D and inhaled steroid dose. Vitamin D was significantly lower in subjects with uncontrolled asthma (Asthma Control Test, ACT≤19) compared to the ones with well controlled symptoms (p<0.05). In subjects with uncontrolled asthma at baseline, ACT scores increased significantly at the end of the study (p<0.04), but not at 4 and 8 weeks. Spirometric values remained unchanged throughout the study. Conclusions Elderly asthmatics very commonly have vitamin D deficiency or insufficiency. Serum vitamin D levels were lower in subjects with uncontrolled asthma. In these subjects, vitamin D supplementation for 12 weeks led to improved ACT scores. Larger, randomized, placebo controlled studies are required to further evaluate whether vitamin D supplementation may improve asthma symptoms in this population. Trial registration ClinicalTrials.gov NCT01730976.
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Affiliation(s)
- Michele Columbo
- Allergy and Immunology Division, Bryn Mawr Hospital, Bryn Mawr, PA USA
| | - Reynold A Panettieri
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Albert S Rohr
- Allergy and Immunology Division, Bryn Mawr Hospital, Bryn Mawr, PA USA
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Luskin AT, Chipps BE, Rasouliyan L, Miller DP, Haselkorn T, Dorenbaum A. Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:544-52.e1-2. [PMID: 25213047 DOI: 10.1016/j.jaip.2014.02.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few data are available that evaluate the relationship among asthma exacerbations, asthma triggers, and asthma-related quality of life (QoL). OBJECTIVE To evaluate the impact of asthma exacerbations and asthma triggers on QoL. METHODS Patients with severe or difficult-to-treat asthma, ages ≥ 13 years (n = 2679) from the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) 3-year observational study were included. Exacerbations were defined hierarchically in descending order of severity (hospitalization, emergency department [ED] visit, steroid burst, no exacerbation) by using data from months 6 and 12. The total number (frequency) of exacerbations was assessed. Asthma-related QoL was measured at month 12 by using the Mini-Asthma QoL Questionnaire (Mini-AQLQ); self-reported asthma triggers were collected at baseline and annually. We used 1-way ANOVA to test for differences in Mini-AQLQ domain scores across asthma exacerbation severity, the total number of asthma exacerbations, and the number of asthma triggers. RESULTS A significant decrease (P < .001) in Mini-AQLQ domain scores was seen with increasing severity of asthma exacerbation (no exacerbation, steroid burst, ED visit, and hospitalization); symptom (5.5, 4.8, 4.3, and 4.2), activity (5.8, 5.2, 4.6, and 4.4), emotional (5.6, 5.0, 4.4, and 4.2), exposure (5.0, 4.5, 4.0, and 3.9); and overall (5.5, 4.9, 4.3, and 4.1). Increasing exacerbation frequency and the number of baseline asthma triggers also were associated with significant decreases in Mini-AQLQ domain scores. An increasing number of asthma triggers were associated with an increase in severity and frequency of exacerbations. CONCLUSION Avoidance of asthma triggers may reduce exacerbation rates and improve asthma-related QoL in patients with severe or difficult-to-treat asthma. Interventional studies are warranted to further explore these outcomes.
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Affiliation(s)
- Allan T Luskin
- Department of Medicine, University of Wisconsin, Madison, Wis.
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Lawrence Rasouliyan
- Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif
| | - Dave P Miller
- Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif
| | | | - Alejandro Dorenbaum
- Department of Pediatric Immunology and Allergy, Stanford University School of Medicine, Stanford, Calif
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Milanese M, Di Marco F, Corsico AG, Rolla G, Sposato B, Chieco-Bianchi F, Costantino MT, Crivellaro MA, Guarnieri G, Scichilone N. Asthma control in elderly asthmatics. An Italian observational study. Respir Med 2014; 108:1091-9. [PMID: 24958604 DOI: 10.1016/j.rmed.2014.05.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exponential increase of individuals aged >64 yrs is expected to impact the burden of asthma. We aimed to explore the level of asthma control in elderly subjects, and factors influencing it. METHODS A multicenter observational study was performed on consecutive patients >64 years old with a documented physician-diagnosis of asthma. Sixteen Italian centers were involved in this 6-month project. FINDINGS A total of 350 patients were enrolled in the study. More than one-third of elderly asthmatic patients, despite receiving GINA step 3-4 antiasthmatic therapy, had an Asthma Control Test score ≤19, with a quarter experiencing at least one severe asthma exacerbation in the previous year. Twenty-nine percent of patients (n = 101) were classified as having Asthma-COPD Overlap Syndrome (ACOS) due to the presence of chronic bronchitis and/or CO lung diffusion impairment. This subgroup of patients had lower mean Asthma Control Test scores and more exacerbations compared to the asthmatic patients (18 ± 4 compared to 20 ± 4, p < 0.01, and 43% compared to 18%, p < 0.01, respectively). Modified Medical Research Council dyspnea mMRC scores and airway obstruction, assessed on the basis of a FEV(1)/FVC ratio below the lower limit of normal, were more severe in ACOS than in asthma, without any difference in responses to salbutamol. In a multivariate analysis, the mMRC dyspnea score, FEV(1)% of predicted and the coexistence of COPD were the only variables to enter the model. INTERPRETATION Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control.
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Affiliation(s)
- M Milanese
- Struttura Complessa di Pneumologia, Azienda Sanitaria Locale 2 Savonese, Pietra Ligure, Italy.
| | - F Di Marco
- Struttura Complessa di Pneumologia Ospedale S. Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - A G Corsico
- Struttura Complessa di Pneumologia, Fondazione IRCCS Policlinico San Matteo, Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | - G Rolla
- Allergologia e Immunologia Clinica Università di Torino, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - B Sposato
- Pneumologia, Azienda Ospedale Misericordia, Grosseto, Italy
| | - F Chieco-Bianchi
- Struttura Complessa di Fisiopatologia Respiratoria, Azienda Ospedaliera di Padova, Padova, Italy
| | - M T Costantino
- Struttura Complessa di Pneumologia, Azienda Ospedaliera Carlo Poma di Mantova, Mantova, Italy
| | - M A Crivellaro
- Servizio di Allergologia, Medicina del Lavoro, Azienda Ospedaliera Università degli Studi di Padova, Padova, Italy
| | - G Guarnieri
- Fisiopatologia Respiratoria, Medicina del Lavoro, Università di Padova, Padova, Italy
| | - N Scichilone
- DIBIMIS, Università degli Studi di Palermo, Palermo, Italy
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Abstract
Recent studies on asthma have demonstrated multiple phenotypes, based on the clinical characteristics of the disease. With the current interest in personalized medicine, the question arises whether the presence of allergic sensitization has any relevance for these phenotypes and the management of asthma. This review will examine the current knowledge of asthma phenotypes and the impact of atopy on asthma diagnosis and severity in adults. In addition, this review will address whether therapies targeted at the atopic axis help improve asthma outcomes, including lung function indices and exacerbations.
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Affiliation(s)
- Sameer K Mathur
- University of Wisconsin School of Medicine, Madison, WI, USA,
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Park HW, Kwon HS, Kim TB, Kim SH, Chang YS, Jang AS, Cho YS, Nahm DH, Park JW, Yoon HJ, Cho YJ, Choi BW, Moon HB, Cho SH. Differences between asthma in young and elderly: results from the COREA study. Respir Med 2013; 107:1509-14. [PMID: 23927852 DOI: 10.1016/j.rmed.2013.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND There has been no large-scale and comprehensive study of the differences between asthma in elderly asthmatics (EA) and non-elderly (i.e. young) asthmatics (NEA). METHODS We performed principal component analysis (PCA) using 2067 asthmatics (434 EA and 1633 NEA) from the Korean Cohort for Reality and Evolution of adult Asthma (COREA). EA was defined as asthmatics with the chronological age of 65 or more and eleven clinical variables measured at enrollment were used for PCA; symptom score, symptom duration, number of exacerbation during previous one year, smoking pack year, number of controller medications, body mass index, predicted % of FEV1, predicted % FVC, post-bronchodilator FEV1/FVC ratio, atopy index and number of eosinophils in peripheral blood. RESULTS PCA of all asthmatics showed that EA and NEA were distinctly separated by the first and second principal component on the plot of individual asthmatics according to their scores. For further analysis, we divided all asthmatics into the EA and the NEA group and performed PCA again in each group. The first four principal components with eigenvalues ≥ 1.0 were identified in both groups and they explained 55.5% of the variance in the EA group and 52.4% in the NEA group respectively. Clinical variables showed distinctly different patterns of loading on the first four principal components between the EA and the NEA group. CONCLUSION EA and NEA have different compositional patterns underlying their clinical variables. These observations helped in understanding the differences between EA and NEA from the integrated view covering various clinical aspects.
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Affiliation(s)
- Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea
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