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Lee HY, Sim DW, Lee Y, Park SY, Lee SK, Lee H, Kim MH, Shim JS, Kang SY, Ban GY, Nam YH, Kim JH, Lee SY, Rhee CK, Song WJ, Kwon JW, Lee T, Kim SR, Park HW, Cho YS, Koh YI, Yoo KH, Lee BJ, Yoon HJ, Park HS, Kim SH. Characteristics of Severe Asthma in the Elderly: Observations From the Korean Severe Asthma Registry (KoSAR). ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:267-278. [PMID: 38910284 PMCID: PMC11199154 DOI: 10.4168/aair.2024.16.3.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/09/2024] [Accepted: 01/26/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Few studies have compared the clinical characteristics of severe asthma (SA) in elderly patients compared to that in nonelderly patients. METHODS We analyzed data from the Korean SA Registry, a nationwide, real-world observational study of SA in Korea. The baseline clinical characteristics, disease control status, and medication use of the patients were compared between elderly (≥ 65 years) and nonelderly groups. RESULTS Of the 864 patients with SA, 260 (30.1%) were in the elderly group. The elderly group had lower atopy rate, but had higher prevalence of chronic obstructive pulmonary disease (COPD), hypertension, and osteoporosis than did the nonelderly group. The elderly group had a lower rate of type 2 inflammation and lower levels of forced expiratory volume in 1 second (FEV1) (% predicted) and FEV1/forced vital capacity ratio than did the nonelderly group (P < 0.05 for all). However, asthma symptom scores and the frequency of asthma exacerbation were not significantly different between the 2 groups. Of controller medications, biologics were less frequently used in the elderly group (P < 0.05 for all). CONCLUSIONS SA in the elderly is characterized by lower lung function, less type 2-low airway inflammation, and comorbidity with COPD. These findings are being taken into consideration in the management of elderly patients with SA in real-world clinical practice.
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Affiliation(s)
- Hwa Young Lee
- Division of Allergy, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Da Woon Sim
- Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Sun-Kyung Lee
- Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Ji-Su Shim
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ga-Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Sook Young Lee
- Division of Allergy, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Taehoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - So Ri Kim
- Division of Respiratory Medicine and Allergy, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Il Koh
- Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang-Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Nishi K, Nagasaki T, Matsumoto H, Oguma T, Terada S, Nomura N, Kogo M, Tashima N, Sunadome H, Murase K, Matsumoto T, Kawaguchi T, Tabara Y, Matsuda F, Sato S, Chin K, Hirai T. Increased blood eosinophils and airflow obstruction as new-onset asthma predictors in the elderly: The Nagahama study. Allergol Int 2024; 73:236-242. [PMID: 38001017 DOI: 10.1016/j.alit.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Asthma in the elderly needs more attention in an aging society. However, it is likely to remain underdiagnosed and undertreated. This study aimed to clarify clinical characteristics of new-onset asthma in the elderly, describing the prevalence, predictive factors, and comorbidities after asthma diagnosis of new-onset asthma in the elderly in the general population. METHODS This community-based prospective cohort study enrolled 9804 generally healthy participants (30-74 years old) in Nagahama City, and conducted a follow-up assessment after 5 years. Elderly participants were those aged ≥65 years at baseline. Patients with new-onset asthma were defined as participants without asthma at baseline assessment and with asthma at the follow-up assessment. RESULTS Among the 7948 participants analyzed in this study, 28 (1.4%) elderly and 130 (2.2%) non-elderly had new-onset asthma. Multiple logistic regression analysis revealed low forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and high blood eosinophil counts at baseline as predicting factors for new-onset asthma in the elderly. Additionally, subsequent incidence of new-onset asthma was higher in elderly participants with both predictors (high blood eosinophil counts and low FEV1/FVC at baseline) than those with none or one of the predictors before asthma diagnosis. Lastly, elderly patients with new-onset asthma had more frequent comorbidity of moderate to severe sleep disordered breathing than those non-elderly. CONCLUSIONS Eosinophilic inflammation and airflow obstruction may predict subsequent new-onset asthma after the age of 65 years. Revealing the characteristics of new-onset asthma in the elderly can aid in the prevention of underdiagnosed asthma.
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Affiliation(s)
- Kenta Nishi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Nagasaki
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Nara, Japan.
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoru Terada
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuko Nomura
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mariko Kogo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriyuki Tashima
- Department of Respiratory Medicine, Kishiwada City Hospital, Osaka, Japan
| | - Hironobu Sunadome
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Chin
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kilpatrick K, Ambrose CS, Lindsley AW, Oppenheimer J. At-home asthma mortality unchanged despite declining mortality in other settings: US death certificate data (2000-2019). Ann Allergy Asthma Immunol 2024; 132:216-222. [PMID: 37848103 DOI: 10.1016/j.anai.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Asthma mortality rates in the United States have declined since 1999; however, asthma mortality by place of death has not been comprehensively evaluated. OBJECTIVE To evaluate temporal trends in asthma mortality rates and place of death in the United States. METHODS We conducted a population-based analysis using data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research platform to evaluate deaths with asthma as the underlying cause (2000-2019) among US residents of all ages. Absolute numbers of asthma-related deaths were described by place of death. Counts were applied to US Census Bureau population counts to calculate mortality rates per 100,000 persons. RESULTS In the 20-year period evaluated, 67,695 asthma deaths were registered in the United States. An overall 32% decline in the asthma mortality rate was observed, from 1.43 to 0.98 per 100,000 persons from 2000 to 2019, respectively. Although asthma mortality rates declined in all medical facility locations, the at-home asthma mortality rate remained stable (0.32 and 0.34 per 100,000 persons in 2000 and 2019, respectively). Consequently, the proportion of at-home asthma deaths increased from 23% in 2000 to 2001 to 36% in 2018 to 2019. The distribution of place of death varied by age, sex, race, ethnicity, and geographic region. CONCLUSION Despite an overall decline in asthma mortality in the United States, at-home asthma mortality has remained unchanged. In recent years, more than one-third of asthma deaths have occurred at home. These findings warrant further study and underscore the importance of increased efforts to identify and treat uncontrolled asthma across demographic groups.
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Affiliation(s)
- Karynsa Kilpatrick
- Center for Observational Research, Amgen Inc, Thousand Oaks, California.
| | - Christopher S Ambrose
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | | | - John Oppenheimer
- Pulmonary and Allergy Associates, Atlantic Medical Group, Atlantic Health System, Morristown, New Jersey
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Gleeson PK, Morales KH, Buckey TM, Fadugba OO, Apter AJ, Christie JD, Himes BE. Factors associated with aeroallergen testing among adults with asthma in a large health system. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100167. [PMID: 37841071 PMCID: PMC10570953 DOI: 10.1016/j.jacig.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 10/17/2023]
Abstract
Background Aeroallergen testing informs precision care for adults with asthma, yet the epidemiology of testing in this population remains poorly understood. Objective We sought to identify factors associated with receiving aeroallergen testing, the results of these tests, and subsequent reductions in exacerbation measures among adults with asthma. Methods We used electronic health record data to conduct a retrospective, observational cohort study of 30,775 adults with asthma who had an office visit with a primary care provider or an asthma specialist from January 1, 2017, to August 26, 2022. We used regression models to identify (1) factors associated with receiving any aeroallergen test and tests to 9 allergen categories after the index visit, (2) factors associated with positive test results, and (3) reductions in asthma exacerbation measures in the year after testing compared with before testing. Results Testing was received by 2201 patients (7.2%). According to multivariable models, receiving testing was associated with having any office visit with an allergy/immunology specialist during the study period (odds ratio [OR] = 91.3 vs primary care only [P < .001]) and having an asthma emergency department visit (OR = 1.62 [P = .004]) or hospitalization (OR = 1.62 [P = .03]) in the year before the index visit. Age 65 years or older conferred decreased odds of testing (OR = 0.74 vs age 18-34 years [P = .008]) and negative test results to 6 categories (P ≤ .04 for all comparisons). Black race conferred increased odds of testing (OR =1.22 vs White race [P = .01]) and positive test results to 8 categories (P < .04 for all comparisons). Exacerbation measures decreased after testing. Conclusion Aeroallergen testing was performed infrequently among adults with asthma and was associated with reductions in asthma exacerbation measures.
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Affiliation(s)
- Patrick K. Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Timothy M. Buckey
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Olajumoke O. Fadugba
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Andrea J. Apter
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jason D. Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Blanca E. Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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Ibrahim B, Achour D, Zerimech F, de Nadai P, Siroux V, Tsicopoulos A, Matran R, Granger V, Nadif R. Plasma thymic stromal lymphopoietin (TSLP) in adults with non-severe asthma: the EGEA study. Thorax 2023; 78:207-210. [PMID: 36517245 DOI: 10.1136/thorax-2022-219192] [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: 05/11/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
Thymic stromal lymphopoietin (TSLP), a cytokine involved in severe asthma treatment, was never studied in non-severe asthma.Among 969 adults from a large epidemiological study, cross-sectional analyses showed that plasma TSLP levels were associated with increased age and BMI, male sex, smoking and high TSLP levels (one IQR increase) with current asthma and poor lung function. High TSLP levels were also associated with persistence of asthma attacks (aOR=2.14 (95% CI 1.23 to 3.72)) and dyspnoea (aOR=2.71 (95% CI 1.39 to 5.28)) 10 years later.Our results suggest that TSLP could be a cytokine of interest in non-severe asthma, and its determinants of circulating levels could be considered in asthma management.
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Affiliation(s)
- Bakari Ibrahim
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Paris, France
| | - Djamal Achour
- Université Lille, CHU Lille, Institut Pasteur de Lille, EA 4483, IMPECS, Lille, France
| | - Farid Zerimech
- Université Lille, CHU Lille, Institut Pasteur de Lille, EA 4483, IMPECS, Lille, France
| | - Patricia de Nadai
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, F-59000 Lille, France
| | - Valerie Siroux
- Université Grenoble Alpes, Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, Grenoble, France
| | - Anne Tsicopoulos
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, F-59000 Lille, France
| | - Régis Matran
- Université Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, Lille, France
| | - Vanessa Granger
- Inserm, Inflammation microbiome immunosurveillance, Université Paris-Saclay, Paris, France.,UF autoimmunité Hypersensibilités et Biothérapies, APHP, HUPNVS, Hôpital Bichat, Paris, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Paris, France
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Won HK, Kang Y, An J, Lee JH, Song WJ, Kwon HS, Cho YS, Moon HB, Jang IY, Kim TB. Relationship between asthma and sarcopenia in the elderly: a nationwide study from the KNHANES. J Asthma 2023; 60:304-313. [PMID: 35225127 DOI: 10.1080/02770903.2022.2047716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Few studies have investigated the relationship between asthma and sarcopenia. We aimed to examine the relationship between asthma and sarcopenia in a community-dwelling geriatric population, especially regarding lung function and asthma control. METHODS A cross-sectional dataset from the Korean National Health and Nutrition Examination Survey 2008-2011 was utilized. Data regarding asthma history, age at asthma onset, recent asthma exacerbations, and hospitalization for asthma exacerbations were obtained using structured questionnaires. Appendicular skeletal muscle was calculated as the sum of the skeletal muscle mass, and physical activity was assessed using the International Physical Activity Questionnaire. RESULTS Asthma presented an estimated incidence of 6.17 ± 0.37% in the elderly. Groups were divided and analyzed according to asthma, muscle mass, and physical activity. Sarcopenia was associated with aging, male sex, smoking history, low body mass index (BMI), and reduced lung function with or without asthma. Sarcopenic asthma had a younger onset and reduced physical activity than non-sarcopenic asthma. Obstructive patterns were more frequent in asthmatics exhibiting low or moderate physical activity levels than in those with high activity, but asthma control was not associated with sarcopenia and physical activity. Multivariate logistic regression analyses showed that compared with control, sarcopenic asthma was associated with FEV1 < 60%, and airway obstruction, and with aging, male, and lower BMI, compared with non-sarcopenic asthma. CONCLUSIONS Our findings suggest that decreased muscle mass and physical activity levels contribute to reduced lung function in elderly asthmatics. Furthermore, sarcopenic asthma was associated with aging, low BMI, and reduced lung function in the elderly.
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Affiliation(s)
- Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.,Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yewon Kang
- Department of Pulmonology and Allergy, Dongkang Hospital, Ulsan, Korea
| | - Jin An
- Department of Pulmonary, Allergy, and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatric Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Suzukawa M, Ohta K, Hashimoto H, Oyamada Y, Miki M, Ogawara M, Inoue Y, Saito AM, Fukutomi Y, Kobayashi N, Taniguchi M. Characterization and cluster analyses of elderly asthma in comparison with nonelderly patients with asthma in Japan. Ann Allergy Asthma Immunol 2023; 130:607-616.e3. [PMID: 36657562 DOI: 10.1016/j.anai.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Asthma is a heterogeneous disease with multiple phenotypes that are useful in precision medicine. As the population ages, the elderly asthma (EA, aged ≥ 65 years) population is growing, and EA is now a major health problem worldwide. OBJECTIVE To characterize EA and identify its phenotypes. METHODS In adult patients with asthma (aged ≥ 18 years) who had been diagnosed with having asthma at least 1 year before study enrollment, 1925 were included in the NHOM-Asthma (registered in UMIN-CTR; UMIN000027776), and the data were used for this study, JFGE-Asthma (registered in UMIN-CTR; UMIN000036912). Data from EA and non-EA (NEA) groups were compared, and Ward's minimum-variance hierarchical clustering method and principal component analysis were performed. RESULTS EA was characterized by older asthma onset, longer asthma duration and smoking history, more comorbidities, lower pulmonary function, less atopic, lower adherence, and more hospital admissions because of asthma. In contrast, the number of eosinophils, total immunoglobulin E level, oral corticosteroid use, and asthma control questionnaire scores were equivalent between EA and NEA. There were 3 distinct phenotypes in EA, which are as follows: EA1: youngest, late onset, short duration, mild; EA2: early onset, long duration, atopic, low lung function, moderate; and EA3: oldest, eosinophilic, overweight, low lung function, most severe. The classification factors of the EA phenotypes included the age of onset and asthma control questionnaire-6. Similarities were observed between EA and NEA phenotypes after principal component analysis. CONCLUSION The EA in Japan may be unique because of the population's high longevity. Characterization of EA phenotypes from the present cohort indicated the need for distinct precision medicine for EA. TRIAL REGISTRATION JFGE-Asthma registered in UMIN-CTR (https://www.umin.ac.jp/ctr/); UMIN000036912.
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Affiliation(s)
- Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Japan Anti-Tuberculosis Association, JATA Fukujuji Hospital, Tokyo, Japan
| | - Hiroya Hashimoto
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Mari Miki
- Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Mitsumasa Ogawara
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuma Fukutomi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | | | - Masami Taniguchi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Shonan Kamakura General Hospital, Kanagawa, Japan
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8
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Khosa JK, Louie S, Lobo Moreno P, Abramov D, Rogstad DK, Alismail A, Matus MJ, Tan LD. Asthma Care in the Elderly: Practical Guidance and Challenges for Clinical Management - A Framework of 5 "Ps". J Asthma Allergy 2023; 16:33-43. [PMID: 36636705 PMCID: PMC9829983 DOI: 10.2147/jaa.s293081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Uncontrolled asthma in the elderly is a public health issue recognized in developed countries such as the United States and among the European Union, both from patient safety and economic perspectives. Variations in the cutoff, which defines elderly age, contribute to epidemiological study difficulties. Nonetheless, the relevance of elderly asthma from a socioeconomic perspective is inarguable. The projected growth of the enlarging geriatric population in the United States portends an impending national health burden that may or may not be preventable with pharmacologic and non-pharmacologic treatments. Asthma in the elderly might be a consequence of uncontrolled disease that is carried throughout a lifetime. Or elderly asthmatics could suffer from uncontrolled asthma, which overlaps with other ailments common with advancing ages that merit consideration, eg, COPD, heart disease, OSA, diabetes mellitus, and other comorbidities. Because of the heterogeneity of asthma phenotypes and other conditions that could mimic the symptoms of elderly asthma, further cohort studies are needed to elucidate the elderly asthmatic pathophysiology and management. More studies to characterize elderly asthma can help address these patients' unmet need for evidence-based guidelines. We introduce the 5 "Ps" (phenotypes, partnership, pharmacology, practice in acute exacerbations, and problems or barriers for the elderly asthmatics) that establish a framework approach for clinical practice.
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Affiliation(s)
- Jaskiran K Khosa
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Samuel Louie
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Pamela Lobo Moreno
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Dmitry Abramov
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Daniel K Rogstad
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael J Matus
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Laren D Tan
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA,Correspondence: Laren D Tan, Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Health, 11234 Anderson Street, Suite 6439, Loma Linda, CA, 92354, USA, Tel +1 909-558-8081, Fax +1 909-558-0581, Email
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9
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Depression in Childhood Asthma vs. Adult-Onset Asthma: A Cross-Sectional Study from the National Health and Nutrition Examination Survey (NHANES). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121797. [PMID: 36553241 PMCID: PMC9776752 DOI: 10.3390/children9121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/27/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
Background: asthma, a chronic respiratory disease caused by inflammation and narrowing of the small airways in the lungs, is the most common chronic childhood disease. Prevalence of childhood asthma in the United States is 5.8%. In boys, prevalence is 5.7% and it is 6% in girls. Asthma is associated with other comorbidities such as major depressive disorder and anxiety disorder. This study explores the association between asthma and depression. Methods: we conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. Asthma and childhood onset asthma were assessed using questionnaires MCQ010 and MCQ025, respectively. Sociodemographic variables were summarized, and univariate analysis was performed to determine the association between asthma and major depressive disorder and its individual symptoms. Results: there were 402,167 participants from 2013−2018 in our study: no asthma in 84.70%; asthma in 15.30%. Childhood onset asthma (COA) included 10.51% and adult-onset asthma (AOA) included 4.79%. Median age of COA is 5 years and AOA is 41 years. Among the asthma groups, most AOA were females (67.77%, p < 0.0001), most COA were males (52.16%, p < 0.0001), and ethnicity was predominantly White in AOA (42.39%, p < 0001) and in COA (35.24%, p < 0.0001). AOA mostly had annual household income from $0−24,999 (35.91%, p < 0.0001), while COA mostly had annual household income from $25,000−64,999 (36.66%, p < 0.0001). There was a significantly higher prevalence of MDD in COA (38.90%) and AOA (47.30%) compared to NOA (31.91%). Frequency of symptoms related to MDD were found to have a significantly higher prevalence and severity in the asthma groups compared to no asthma, and slightly greater and more severe in AOA than in COA. Symptoms include having little interest in doing things (COA 18.38% vs. AOA 22.50% vs. NOA 15.44%), feeling down, depressed, or hopeless (COA 20.05% vs. AOA 22.77% vs. NOA 15.85%), having trouble sleeping or sleeping too much (COA 27.38% vs. AOA 23.15% vs. NOA 22.24%), feeling tired or having little energy (COA 39.17% vs. AOA 34.24% vs. NOA 33.97%), having poor appetite or overeating (COA 19.88% vs. AOA 20.02% vs. NOA 15.11%), feeling bad about yourself (COA 13.90% vs. AOA 13.79% vs. NOA 10.78%), having trouble concentrating on things (COA 12.34% vs. AOA 14.41% vs. NOA 10.06%), moving or speaking slowly or too fast (COA 8.59% vs. AOA 9.72% vs. NOA 6.09%), thinking you would be better off dead (COA 3.12% vs. AOA 4.38% vs. NOA 1.95%) and having the difficulties these problems have caused (COA 21.66% vs. AOA 26.73% vs. NOA 19.34%, p < 0.0001). Conclusion: MDD and related symptoms were significantly higher and more severe in participants with asthma compared to no asthma. Between adult-onset asthma compared to childhood onset asthma, adult-onset asthma had slightly greater and more severe MDD and related symptoms compared to childhood onset asthma.
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10
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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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11
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Ramey OL, Silva Almodóvar A, Nahata MC. Medication adherence in Medicare-enrolled older adults with asthma before and during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2022; 128:561-567.e1. [PMID: 35227901 PMCID: PMC8873040 DOI: 10.1016/j.anai.2022.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Data regarding medication adherence in older adults with asthma before and during the coronavirus disease 2019 (COVID-19) pandemic are lacking. OBJECTIVE To evaluate medication adherence and determine factors associated with adherence in Medicare-enrolled older adults with asthma before and during the COVID-19 pandemic. METHODS This was a retrospective cohort analysis of Medicare-enrolled patients with asthma. Medication adherence was measured using rates of proportion of days covered for dates January to July 2019 and January to July 2020. Patients less than 65 years of age, with chronic obstructive pulmonary disease, or with cystic fibrosis were excluded. Paired t tests assessed change in adherence between 2019 and 2020. Logistic regression evaluated association of age, sex, depression, moderate or severe asthma, use of a 90-day supply, having 3 or more albuterol fills, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, and systemic corticosteroid fills with high adherence (proportion of days covered ≥ 80%). RESULTS Mean adherence to asthma controller medications ranged from 75% to 90%, in 2019. Adherence significantly decreased (P < .001) from 51% to 70% for all controller medications, except theophylline in 2020. Similar results were observed among patients with moderate or severe asthma. In 2019 and 2020, number of controller medications, 3 or more albuterol fills, and having a 90-day supply were associated with high adherence (P < .001). CONCLUSION Adherence to asthma controller medications decreased considerably during the COVID-19 pandemic among Medicare-enrolled patients with asthma. Patients with markers for more severe asthma, overuse of albuterol, and a 90-day supply of controller medications were more likely to have high adherence. These findings can be used to identify opportunities to improve adherence and prescribing among adult patients with asthma.
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Affiliation(s)
- Olivia L Ramey
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio; Tabula Rasa HealthCare, Tucson, Arizona
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio; College of Medicine, The Ohio State University, Columbus, Ohio.
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12
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Sex Plays a Multifaceted Role in Asthma Pathogenesis. Biomolecules 2022; 12:biom12050650. [PMID: 35625578 PMCID: PMC9138801 DOI: 10.3390/biom12050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Sex is considered an important risk factor for asthma onset and exacerbation. The prevalence of asthma is higher in boys than in girls during childhood, which shows a reverse trend after puberty—it becomes higher in adult females than in adult males. In addition, asthma severity, characterized by the rate of hospitalization and relapse after discharge from the emergency department, is higher in female patients. Basic research indicates that female sex hormones enhance type 2 adaptive immune responses, and male sex hormones negatively regulate type 2 innate immune responses. However, whether hormone replacement therapy in postmenopausal women increases the risk of current asthma and asthma onset remains controversial in clinical settings. Recently, sex has also been shown to influence the pathophysiology of asthma in its relationship with genetic or other environmental factors, which modulate asthmatic immune responses in the airway mucosa. In this narrative review, we highlight the role of sex in the continuity of the asthmatic immune response from sensing allergens to Th2 cell activation based on our own data. In addition, we elucidate the interactive role of sex with genetic or environmental factors in asthma exacerbation in women.
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13
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Lugogo N, Judson E, Haight E, Trudo F, Chipps BE, Trevor J, Ambrose CS. Severe asthma exacerbation rates are increased among female, Black, Hispanic, and younger adult patients: results from the US CHRONICLE study. J Asthma 2022; 59:2495-2508. [PMID: 35000529 DOI: 10.1080/02770903.2021.2018701] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe clinical outcomes in patients with severe asthma (SA) by common sociodemographic determinants of health: sex, race, ethnicity, and age. METHODS CHRONICLE is an observational study of subspecialist-treated, United States adults with SA receiving biologic therapy, maintenance systemic corticosteroids, or uncontrolled by high-dosage inhaled corticosteroids with additional controllers. For patients enrolled between February 2018 and February 2020, clinical characteristics and asthma outcomes were assessed by sex, race, ethnicity, age at enrollment, and age at diagnosis. Treating subspecialists reported exacerbations, exacerbation-related emergency department visits, and asthma hospitalizations from 12 months before enrollment through the latest data collection. Patients completed the St. George's Respiratory Questionnaire and the Asthma Control Test at enrollment. RESULTS Among 1884 enrolled patients, the majority were female (69%), reported White race (75%), non-Hispanic ethnicity (69%), and were diagnosed with asthma as adults (60%). Female, Black, Hispanic, and younger patients experienced higher annualized rates of exacerbations that were statistically significant compared with male, White, non-Hispanic, and older patients, respectively. Black, Hispanic, and younger patients also experienced higher rates of asthma hospitalizations. Female and Black patients exhibited poorer symptom control and poorer health-related quality of life. CONCLUSIONS In this contemporary, real-world cohort of subspecialist-treated adults with SA, female sex, Black race, Hispanic ethnicity, and younger age were important determinants of health, potentially attributable to physiologic and social factors. Knowledge of these disparities in SA disease burden among subspecialist-treated patients may help optimize care for all patients. Supplemental data for this article is available online at at www.tandfonline.com/ijas .
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Affiliation(s)
| | | | | | | | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA
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14
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Feldman JM, Becker J, Arora A, DeLeon J, Torres-Hernandez T, Greenfield N, Wiviott A, Jariwala S, Shim C, Federman AD, Wisnivesky JP. Depressive Symptoms and Overperception of Airflow Obstruction in Older Adults With Asthma. Psychosom Med 2021; 83:787-794. [PMID: 33938504 PMCID: PMC8419010 DOI: 10.1097/psy.0000000000000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older adults are at increased risk for depression and poor asthma outcomes. We examined whether depressive symptoms are associated with overperception of airflow obstruction and a pattern of worse asthma control, but not pulmonary function. METHODS We recruited a cohort of adults with asthma 60 years and older in East Harlem and the Bronx, New York. Baseline measures included the Geriatric Depression Scale, Asthma Control Questionnaire, and Mini Asthma Quality of Life Questionnaire. Spirometry was conducted at baseline to assess pulmonary function. Perception of airflow obstruction was assessed for 6 weeks following baseline by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter followed by PEF blows. Participants were blinded to actual PEF values. The percentage of time that participants were in the overperception zone was calculated as an average. RESULTS Among the 334 participants (51% Hispanic, 25% Black), depressive symptoms were associated with overperception of airflow obstruction (β = 0.14, p = .029), worse self-reported asthma control (β = 0.17, p = .003), and lower asthma-related quality of life (β = -0.33, p < .001), but not with lung function (β = -0.01, p = .82). Overperception was also associated with worse self-reported asthma control (β = 0.14, p = .021), but not lung function (β = -0.05, p = .41). CONCLUSIONS Depressive symptoms were associated with greater perceived impairment from asthma, but not pulmonary function. Overperception of asthma symptoms may play a key role in the relationship between depression and asthma outcomes in older adults.
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Affiliation(s)
- Jonathan M Feldman
- From the Ferkauf Graduate School of Psychology (Feldman, Greenfield, Wiviott), Yeshiva University; Division of Academic General Pediatrics, Department of Pediatrics (Feldman, DeLeon, Torres-Hernandez), Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx; Division of General Internal Medicine (Becker, Arora, Federman, Wisnivesky), Icahn School of Medicine at Mount Sinai, New York; Division of Allergy/Immunology, Department of Medicine (Jariwala), Albert Einstein College of Medicine/Montefiore Medical Center; Division of Pulmonary Medicine, Department of Medicine (Shim), Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; and Division of Pulmonary, Critical Care and Sleep Medicine (Wisnivesky), Icahn School of Medicine at Mount Sinai, New York, New York
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15
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Patterson ME, Bollinger S, Coleman C, Rhodes JAM. Medication discrepancy rates and sources upon nursing home intake: A prospective study. Res Social Adm Pharm 2021; 18:2830-2836. [PMID: 34176761 DOI: 10.1016/j.sapharm.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Medication discrepancies at nursing home intake increase the risk of drug-related adverse events. Measuring discrepancy incidence rates and locating the origins of discrepancies can assist in identifying information exchange deficits for high-risk medications. OBJECTIVE To determine class-specific discrepancy rates, to determine discordance between medication lists, and to explore patient and system-level factors associated with medication discrepancies discovered between the first and second medication reconciliations conducted at nursing home intake. METHODS Medication discrepancy data were prospectively collected from four long-term care facilities over a 9-month period. Medication discrepancies were defined as mismatched prescribing orders between at least two medication history lists. Discrepancy locations were defined as the pairs or triads of facilities between which medication history lists were discordant. Unadjusted logistic regressions were used to identify medication classes with the highest discrepancy rates and patient factors significantly associated with any medication discrepancy. RESULTS 40.8% of newly admitted or re-admitted residents and 6.3% of medications reviewed had at least one medication discrepancy discovered during the second medication reconciliation conducted at nursing home intake. Residents prescribed fewer than 14 medications were at less risk of discrepancies. Residents with Charlson Comorbidity Index of 5, COPD, HF, anemia or HTN were at greater risk of discrepancies. Respiratory and analgesic medications were twice as likely as other medication classes to be discrepant (OR = 2.2, 95% CI 1.2-4.4; OR = 2.2, 95% CI 1.3-3.5). Most discrepancies occurred between hospital and nursing home lists (44.9%), or between the hospital, nursing home, and community pharmacy lists (39.3%) CONCLUSIONS: Given the higher risk of discrepancies within respiratory or analgesics, transitions of care teams need to prioritize residents with respiratory conditions or pain. Although re-admitted residents' increased discrepancy risk is likely due to poorer health status, miscommunications across the nursing home, hospital and community pharmacy require further research to clarify system failures.
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Affiliation(s)
- Mark E Patterson
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA.
| | | | - Chandler Coleman
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - James A M Rhodes
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
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16
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Coulson E, Carpenter LM, Georgia TE, Baptist AP. Breathing exercises in older adults with asthma: a blinded, randomized, placebo-controlled trial. J Asthma 2021; 59:1438-1444. [PMID: 34044738 DOI: 10.1080/02770903.2021.1936015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Breathing exercises have been found to benefit patients with some respiratory disorders, but can take a significant amount of time to complete. The effects of a breathing exercise program are unknown. The aim of this study was to evaluate the effectiveness of a short multi-component exercise program for older adults with asthma. METHODS To be included, subjects were age 65 years or older with persistent asthma. 90 subjects with predominantly moderate to severe asthma were randomized, 45 each, into either the exercise or control groups. After in person training at the initial visit, those in the exercise group performed a short three-part exercise program twice per day at home for one month. Those in the control group performed 2 breaths with the incentive spirometer twice per day. At the initial visit patients completed baseline questionnaires assessing demographic information, asthma control (Asthma Control Test - ACT) and quality of life (mini-Asthma Quality of Life Questionnaire - mini-AQLQ) as well as spirometry. After the one-month period at the follow-up visit the ACT, mini-AQLQ, and spirometry were repeated. RESULTS Subjects in the intervention felt that breathing exercises were helpful, and 87% would recommend them to a friend. Although both groups had improvement in ACT and mini-AQLQ, there were no differences between groups. FEV1 was lower in both groups. CONCLUSION Although a short breathing exercise program was acceptable for older adults with asthma, it did not produce meaningful improvements in asthma outcomes. A longer program may be necessary.
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Affiliation(s)
- Elise Coulson
- Allergy Partners of Western North Carolina, Asheville, NC, USA.,Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Laurie M Carpenter
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Todd E Georgia
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
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17
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Ishii T, Shiota S, Yamamoto K, Abe K, Miyazaki E. Inhaled Corticosteroid-Containing Regimens Reduce Hospitalizations and Healthcare Costs among Elderly Asthmatics: Real-World Validation Using the National Health Insurance Claims Database. TOHOKU J EXP MED 2021; 251:135-145. [PMID: 32595201 DOI: 10.1620/tjem.251.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The high rates of mortality and hospitalization among elderly asthmatics, as well as their increasing healthcare costs have become an important public health issue. It would be worthwhile to assess whether inhaled corticosteroid (ICS) can resolve these problems. To explore ICS prescription rates for elderly asthmatics and the factors influencing them and to investigate their association with hospitalization and healthcare costs, we analyzed data from the National Health Insurance Claims Database for the same time frame (December 1 to February 28) across three different periods (2011-2012; 2014-2015; and 2017-2018), from which we identified 6,619, 5,619, and 6,880 elderly individuals, respectively. The prescription rates of ICS increased (52.8%, 65.5% and 68.8%, in the first, second and third survey period, respectively) and inversely the hospital admission rates declined (3.7%, 3.2% and 2.5%, in the first, second and third survey period, respectively). The total healthcare costs per month were significantly lower for patients who received ICS-containing regimens than for those who did not. A multivariate analysis revealed that increasing age, rural residence, receiving a prescription from a clinic, hospital admission, and prescription of asthma medications other than ICS were associated with non-prescription of ICS, whereas cross-boundary treatment increased the ICS-prescription rate. Our study suggests that increases in the prescription rate of ICS are associated with reduced hospital admission rates and lower medical costs in the real-world. ICS prescription rates in rural areas and at clinics, which remain low, need to be increased.
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Affiliation(s)
- Toshihiro Ishii
- Department of General Medicine, Oita University Faculty of Medicine.,Center for Community Medicine, Oita University Faculty of Medicine
| | - Seiji Shiota
- Department of General Medicine, Oita University Faculty of Medicine.,Center for Community Medicine, Oita University Faculty of Medicine
| | - Kyoko Yamamoto
- Department of General Medicine, Oita University Faculty of Medicine.,Medical Education Center, Oita University Faculty of Medicine
| | - Koh Abe
- Department of General Medicine, Oita University Faculty of Medicine.,Center for Community Medicine, Oita University Faculty of Medicine
| | - Eishi Miyazaki
- Department of General Medicine, Oita University Faculty of Medicine.,Center for Community Medicine, Oita University Faculty of Medicine
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18
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Busse PJ, McDonald VM, Wisnivesky JP, Gibson PG. Asthma Across the Ages: Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1828-1838. [PMID: 32499032 DOI: 10.1016/j.jaip.2020.03.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 02/06/2023]
Abstract
Asthma is a common disease affecting approximately 300 million people worldwide, across all age ranges. Despite advances in asthma outcomes of the last few decades, there remains room for improvement in asthma management and for patient outcomes, particularly in older patients. The heterogeneity of asthma is now well recognized, and is known to complicate response to treatment and patient behavior and impact health outcomes. Asthma and its heterogeneity change according to age. Asthma affects people differently across the life span. In adults, prevalence is highest among those in middle age; however, mortality is greater in the older age group. In this clinical commentary, we describe how age impacts asthma prevalence and incidence, outcomes, disease expression, and approach to management in adulthood and in older patients.
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Affiliation(s)
- Paula J Busse
- Division of Allergy and Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia; Viruses, Immunology, Vaccines, Asthma (VIVA) Programme, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia; Viruses, Immunology, Vaccines, Asthma (VIVA) Programme, Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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19
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Chan KP, Ko FWS, Ling KC, Cheung PS, Chan LV, Chan YH, Lo YT, Ng CK, Lui MMS, Yee KSW, Tseng CZS, Tse PY, Wong MLM, Choo KL, Lam WK, Wong CM, Ho SS, Lun CT, Lai CKW. A territory-wide study on the factors associated with recurrent asthma exacerbations requiring hospitalization in Hong Kong. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:569-581. [PMID: 33657275 PMCID: PMC8127557 DOI: 10.1002/iid3.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
Background The real‐world relationships between the demographic and clinical characteristics of asthma patients, their prehospitalization management and the frequency of hospitalization due to asthma exacerbation is poorly established. Objective To determine the risk factors of recurrent asthma exacerbations requiring hospitalizations and evaluate the standard of baseline asthma care. Methods A territory‐wide, multicentre retrospective study in Hong Kong was performed. Medical records of patients aged ≥18 years admitted to 11 acute general hospitals from January 1 to December 31, 2016 for asthma exacerbations were reviewed. Results There were 2280 patients with 3154 admissions (36.7% male, median age 66.0 [interquartile range: 48.0–81.0] years, 519 had ≥2 admissions). Among them, 1830 (80.3%) had at least one asthma‐associated comorbidity, 1060 (46.5%) and 885 (38.9%) of patients had Accident and Emergency Department (AED) attendance and hospitalization in the preceding year, respectively. Patients with advancing age (incidence rate ratio [IRR]: 1.003 for every year increment), a history of AED visits or hospitalization (IRR: 1.018 and 1.070 for every additional episode, respectively) for asthma exacerbation in the preceding year, the presence of neuropsychiatric (IRR: 1.142) and gastrointestinal (IRR: 1.154) comorbidities were risk factors for an increasing number of admissions for asthma exacerbation. For patients with ≥2 admissions, 17.1% were not prescribed inhaled corticosteroid and only 44.6% had spirometry checked before the index admission. Asthma phenotyping was often incomplete, as assessment of atopy (total serum immunoglobulin E level and senitization to aeroallergens) was only performed in 30 (5.8%) patients with ≥2 admissions. Conclusions and Clinical Relevance Improving asthma care, especially in elderly patients with a prior history of urgent healthcare utilization and comorbidities, may help reduce healthcare burden. Suboptimal management before the index admission was common in patients hospitalized for asthma exacerbations. Early identification of patients at risk and enhancement of baseline asthma management may help to prevent recurrent asthma exacerbation and subsequent hospitalization.
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Affiliation(s)
- Ka Pang Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Fanny Wai San Ko
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kwun Cheung Ling
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Pik Shan Cheung
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Lee Veronica Chan
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Yu Hong Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Yi Tat Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chun Kong Ng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Macy Mei-Sze Lui
- Department of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | | | | | - Pak Yiu Tse
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Mo Lin Maureen Wong
- Department of Medicine & Geriatrics, Caritas Medical Centre, Hong Kong, China
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Wai Kei Lam
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Chun Man Wong
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Sheng Sheng Ho
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Chung Tat Lun
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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20
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Corlateanu A, Stratan I, Covantev S, Botnaru V, Corlateanu O, Siafakas N. Asthma and stroke: a narrative review. Asthma Res Pract 2021; 7:3. [PMID: 33608061 PMCID: PMC7896413 DOI: 10.1186/s40733-021-00069-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 02/08/2023] Open
Abstract
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation, bronchial reversible obstruction and hyperresponsiveness to direct or indirect stimuli. It is a severe disease causing approximately half a million deaths every year and thus possessing a significant public health burden. Stroke is the second leading cause of death and a major cause of disability worldwide. Asthma and asthma medications may be a risk factors for developing stroke. Nevertheless, since asthma is associated with a variety of comorbidities, such as cardiovascular, metabolic and respiratory, the increased incidence of stroke in asthma patients may be due to a confounding effect. The purpose of this review is to analyze the complex relationship between asthma and stroke.
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Affiliation(s)
- A. Corlateanu
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - Iu Stratan
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - S. Covantev
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - V. Botnaru
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - O. Corlateanu
- Department of Internal Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - N. Siafakas
- Department of Thoracic Medicine, University General Hospital, Stavrakia, 71110 Heraklion, Crete, Greece
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MAHDAVIAZAD HAMIDEH, SHAHROKHI SHERVINDOKHT, MASOOMPUR SEYEDMASOOM. Socioeconomic-related determinants of asthma in the elderly. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 61:E578-E583. [PMID: 33628964 PMCID: PMC7888395 DOI: 10.15167/2421-4248/jpmh2020.61.4.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022]
Abstract
Introduction As the population ages, the impact of asthma in the elderly is expected to be enhanced over the forthcoming decades. We investigated the prevalence of asthma and its socioeconomic factors in the elderly, Shiraz, Iran. Methods In this population-based study, 1527 subjects older than 60 years were selected based on the stratified random sampling method. The data on asthma symptoms, current asthma, physician diagnose asthma, and allergic rhinitis were collected using the translated ECRHS (European Community Respiratory Health Survey) questionnaire. Information on individual socioeconomic status was derived from the participants' self-reported educational level and their occupation, income, and residence. A p-value of less than 0.05 was considered to be statistically significant. Results The prevalence of asthma, current asthma, physician diagnose asthma, and allergic rhinitis was found to be 8.97, 6.81, 4.78 and, 23.51%, respectively. The most common asthma symptoms were nocturnal chest tightness (15.52%, n = 237/1,527). In univariate analysis, the prevalence of asthma was higher in illiterate patients (12.7%), subjects with the lowest income level (10.6%), and patients living in urban areas (24.1%). Having age more than 80 (OR = 2.01; 95% CI = 1.10-3.65), being a current smoker (OR = 2.76; 95% CI = 1.69-4.51) and living in a suburban area (OR = 3.01; 95% CI = 1.20-7.50) were significant predictive factors for asthma in the regression model. Conclusions Asthma and allergic rhinitis in the elderly should be more focus in the southwest of Iran. Moreover, our findings highlighted the effect of socio- economic status, disparities and inequality on community health.
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Affiliation(s)
- HAMIDEH MAHDAVIAZAD
- Department of Family Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - SEYED MASOOM MASOOMPUR
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Seyed Masoom Masoompur, Shiraz University of Medical Sciences 6 floor, Administration Building Zand St., Shiraz, Iran - E-mail:
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Bergantin LB. The Interplay Between Asthma and Other Diseases: Role of Ca2+/cAMP Signalling. Endocr Metab Immune Disord Drug Targets 2021; 20:321-327. [PMID: 31456527 DOI: 10.2174/1871530319666190828145854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Asthma is correlated with a higher risk of manifesting other diseases, including hypertension, diabetes, obesity, psychiatric and neurological diseases, and cancer. Therefore, revealing this interplay between asthma and these illnesses may provide novel insights into their pathogenesis. RESULTS It is highly debated that dysregulation of Ca2+ homeostasis is involved in the pathogenesis of these maladies. Not surprisingly, calcium (Ca2+) channel blockers (CCBs), classically used as antihypertensive medicines, have been demonstrating off-label effects such as alleviating asthma symptoms, in addition to antidiabetic, antiobesity, anticancer and antineurodegenerative effects. Our studies about Ca2+/cAMP signalling may shed some new light on this field. CONCLUSION Thus, considering that asthma and associated illnesses such as hypertension, diabetes, obesity, cancer and neurodegenerative diseases have become highly prevalent medical problems in the world, the comprehension of this interplay between asthma and other disorders could improve drug therapy.
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Affiliation(s)
- Leandro B Bergantin
- Department of Pharmacology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Pedro de Toledo 669, Vila Clementino, Sao Paulo, Brazil
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Anderson WC, Gondalia R, De Keyser HE, Kaye L, Szefler SJ, Stempel DA. Digital assessment of medication utilization by age and diagnosis of asthma or COPD. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1723-1725. [PMID: 33212238 DOI: 10.1016/j.jaip.2020.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 01/20/2023]
Affiliation(s)
- William C Anderson
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | | | - Heather E De Keyser
- Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | | | - Stanley J Szefler
- Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Choi K, Han S, Suh HS. Emergency department visits and hospitalisations for emergent asthmatic symptoms from 2014 to 2016: cross-sectional study in Korea. BMJ Open 2020; 10:e036237. [PMID: 32792435 PMCID: PMC7430419 DOI: 10.1136/bmjopen-2019-036237] [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: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the characteristics of emergent patients with asthma who visited emergency departments (EDs) in Korea, and the consequences of these visits. DESIGN Retrospective cross-sectional study. SETTING We used data from the National Emergency Department Information System database from 2014 to 2016. The data included reports collected from 408 EDs in Korea. PARTICIPANTS We analysed the ED cases for asthma-related emergent symptoms that met the following inclusion criteria: (1) had a main diagnosis code of asthma (International Classification of Diseases 10th Revision code: J45/J46), and (2) recorded as an emergent symptom in the EDs. RESULTS During 2014-2016, there were 58 713 ED visits related to an asthma diagnosis with emergent symptoms. Following an ED visit, 31.69% were hospitalised, of which 89.88% were admitted to the general wards, and 10.12% to the intensive care units (ICUs). More than 50% of the hospitalised cases included in the group ≥70 years of age. The incidence of death during hospitalisation generally increased with age and the proportion of death in ICU exceeded 10% among the group ≥70 years. The ratio of ICU/general ward admission at the arrival time of 0-03:00, in the ≥60 years age group was the highest compared with other times of the day and age groups. CONCLUSIONS We found that among all age groups, ED visits by older patients resulted in more ICU admissions. Our results can help in providing a better understanding of medical resource utilisation by emergent patients with asthma.
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Affiliation(s)
- Kyungseon Choi
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Sola Han
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Hae Sun Suh
- College of Pharmacy, Pusan National University, Busan, South Korea
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Lin MP, Vargas-Torres C, Schuur JD, Shi D, Wisnivesky J, Richardson LD. Trends and predictors of hospitalization after emergency department asthma visits among U.S. Adults, 2006-2014. J Asthma 2020; 57:811-819. [PMID: 31112431 PMCID: PMC8820214 DOI: 10.1080/02770903.2019.1621889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Background: Asthma hospitalizations are an ambulatory care-sensitive condition; a majority originate in emergency departments (EDs).Objective: Describe trends and predictors of adult asthma hospitalizations originating in EDs.Methods: Observational study of ED visits resulting in hospitalization using a nationally representative sample. We tested trend in hospitalization rates from 2006 to 2014 using logistic regression, then assessed the association between hospitalization rates and patient and hospital characteristics using hierarchical multivariable regression accounting for hospital-level clustering.Results: Total ED asthma visits increased 15% from 2006 to 2014, from 1.06 to 1.22 million, while the likelihood of hospitalization decreased (20.9-18.2%, p < 0.01). Adjusting for increased asthma prevalence, ED visit rates and hospitalization rates decreased by 10 and 21%, respectively. Hospitalization was independently associated with older age, female gender (OR = 1.23, 95% CI 1.20-1.26), higher Charlson score (OR = 1.99, 95% CI 1.97-2.01), Medicaid (OR = 1.05, 95% CI 1.01-1.08) and Medicare (OR = 1.26, 95% CI 1.22-1.31) insurance, and trauma centers (OR = 1.34, 95% CI 1.12-1.60). Hospitalization was less likely for uninsured visits (OR = 0.7, 95% CI 0.67-0.73), lower income areas (OR = 0.89, 95% CI 0.85-0.93), non-metropolitan teaching hospitals (OR = 0.83, 95% CI 0.71-0.96), Midwestern (OR = 0.84, 95% CI 0.69-1.01) or Western regions (OR 0.69, 95% CI 0.56-0.83). Unmeasured hospital-specific effects account for 15.8% of variability in hospital admission rates after adjusting for patient and hospital factors.Conclusions: Total asthma ED visits increased, but prevalence-adjusted ED visits, and ED hospitalization rates have declined. Uninsured patients have disproportionately more ED visits but 30% lower odds of hospitalization. Substantial variation implies unmeasured clinical, social and environmental factors accounting for hospital-specific differences in hospitalization.
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Affiliation(s)
- Michelle P. Lin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carmen Vargas-Torres
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeremiah D. Schuur
- Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Dorothy Shi
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Hough KP, Curtiss ML, Blain TJ, Liu RM, Trevor J, Deshane JS, Thannickal VJ. Airway Remodeling in Asthma. Front Med (Lausanne) 2020; 7:191. [PMID: 32509793 PMCID: PMC7253669 DOI: 10.3389/fmed.2020.00191] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Asthma is an inflammatory disease of the airways that may result from exposure to allergens or other environmental irritants, resulting in bronchoconstriction, wheezing, and shortness of breath. The structural changes of the airways associated with asthma, broadly referred to as airway remodeling, is a pathological feature of chronic asthma that contributes to the clinical manifestations of the disease. Airway remodeling in asthma constitutes cellular and extracellular matrix changes in the large and small airways, epithelial cell apoptosis, airway smooth muscle cell proliferation, and fibroblast activation. These pathological changes in the airway are orchestrated by crosstalk of different cell types within the airway wall and submucosa. Environmental exposures to dust, chemicals, and cigarette smoke can initiate the cascade of pro-inflammatory responses that trigger airway remodeling through paracrine signaling and mechanostimulatory cues that drive airway remodeling. In this review, we explore three integrated and dynamic processes in airway remodeling: (1) initiation by epithelial cells; (2) amplification by immune cells; and (3) mesenchymal effector functions. Furthermore, we explore the role of inflammaging in the dysregulated and persistent inflammatory response that perpetuates airway remodeling in elderly asthmatics.
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Affiliation(s)
- Kenneth P Hough
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Miranda L Curtiss
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Trevor J Blain
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rui-Ming Liu
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer Trevor
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessy S Deshane
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Victor J Thannickal
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Alturaiki WH. Evaluation of C-C Chemokine Ligand 5 (CCL5) Chemokine, Interleukin 5 (IL-5) Cytokine, and Eosinophil Counts as Potential Biomarkers in Saudi Patients with Chronic Asthma During Sandstorms. Cureus 2020; 12:e7809. [PMID: 32467785 PMCID: PMC7249775 DOI: 10.7759/cureus.7809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and objectives Asthma is a common chronic inflammatory disorder of the lung that can be exacerbated by environmental triggers during sandstorms. This study aimed to evaluate the usefulness of C-C chemokine ligand 5 (CCL5) chemokine and interleukin 5 (IL-5) cytokine and determine the total eosinophil count in blood and sputum for use as biomarkers in Saudi patients with chronic asthma who visited emergency departments during sandstorms. Methods The study included 42 Saudi patients with chronic asthma and 20 healthy controls. Plasma levels of CCL5, IL-5, and total immunoglobulin E (IgE) were measured using a specific enzyme-linked immunosorbent assay (ELISA). Total eosinophils in peripheral blood were counted using a hematology analyzer (CELL-DYN Ruby System; Abbott Diagnostics, Chicago, Illinois); in sputum, eosinophils stained with Giemsa were examined under a microscope, counted, and expressed as a percentage of the total cells. Results Total IgE levels were significantly higher in patients with asthma (mean 433 IU/ml, P = 0.0001) as compared to normal controls (139 IU/ml). There was no significant difference in the levels of CCL5 in patients with asthma (625 pg/ml) as compared to normal controls (663 pg/ml, P = 0. 57). No correlation was found between total IgE and CCL5 levels. IL-5 was not detected in patients with asthma or in controls. Moreover, the total counts of eosinophils in the blood did not increase in patients with asthma as compared to controls while eosinophils in sputum samples were increased in the former (mean =3.128%). Conclusion Plasma levels of CCL5 and IL-5 or eosinophil counts in the peripheral blood may not be useful diagnostic biomarkers to evaluate airway inflammation and monitor asthma severity. Conversely, the sputum eosinophil count may represent a useful diagnostic marker for assessing the magnitude of asthma exacerbation during sandstorms.
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Affiliation(s)
- Wael H Alturaiki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, SAU
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Bruhl RJ, Perkison WB, Hanania NA, McNeill LH, Oluyomi AO, Fiesinger EB, Minard CG, Solomon A, Hamilton WJ, Butler B, Caldwell J, Crosby E, Davis C, Galvan H, Harris R, Lacour-Chestnut F, Martin C, Pannell S, Phipps K, Richardson G, Solomon A, White W, Boles J, Rangel A, Virk R, Brock M, Guffey D, Ramamurthy U, Persse D, Maffei S, Chan W, Reyes B. Design of a home-based intervention for Houston-area African-American adults with asthma: Methods and lessons learned from a pragmatic randomized trial. Contemp Clin Trials 2020; 91:105977. [PMID: 32151753 DOI: 10.1016/j.cct.2020.105977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
A growing body of evidence demonstrates that home-based, multicomponent interventions can effectively reduce exposures to asthma triggers and decrease asthma symptoms. However, few of these studies have targeted adults. To address this and other research gaps, we designed and implemented a pragmatic randomized clinical trial, the Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIITBAC) for African Americans, to assess the effectiveness of a home-based intervention to improve asthma control and quality of life in African-American adults-a population disproportionately affected by asthma. The primary goals were to help participants reduce allergens and irritants in their homes and better manage their disease through knowledge, improved medication use, and behavior change. HIITBAC had two groups: clinic-only and home-visit groups. Both groups received enhanced clinical care, but the home-visit group also received a detailed home assessment and four additional home visits spaced over roughly one year. We recruited 263 participants. Of these, 152 (57.8%) were recruited through electronic health record data, 51 (19.4%) through Emergency Medical Services data, and 60 (22.8%) through other efforts (e.g., emergency departments, community events, outreach). Seventy participants (26.6%) were lost to follow up, substantially more in the home-visit than in the clinic-only group. We describe the HIITBAC methodology and cohort, discuss lessons learned about recruitment and retention, and highlight adaptations we implemented to address these lessons.
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Affiliation(s)
- Rebecca Jensen Bruhl
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - William Brett Perkison
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abiodun O Oluyomi
- Section of Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ellen Baskin Fiesinger
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Abida Solomon
- College of Nursing, Prairie View A&M University, Houston, TX, United States
| | - Winifred J Hamilton
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Brian Butler
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - James Caldwell
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Eunice Crosby
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Cellie Davis
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Hope Galvan
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Rachel Harris
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | | | - Carol Martin
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Shereda Pannell
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Kathy Phipps
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | | | - Adriene Solomon
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - William White
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Jamie Boles
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Adriana Rangel
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ritupreet Virk
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Melissa Brock
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Uma Ramamurthy
- Office of Research Information Technology, Baylor College of Medicine, Houston, TX, United States
| | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States; Emergency Medical Services, Houston Fire Department, City of Houston, TX, United States
| | - Salvador Maffei
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Wenyaw Chan
- Department of Biostatistics, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Brenda Reyes
- U.S. Department of Housing & Urban Development, Washington, DC, United States
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Long B, Lentz S, Koyfman A, Gottlieb M. Evaluation and management of the critically ill adult asthmatic in the emergency department setting. Am J Emerg Med 2020; 44:441-451. [PMID: 32222313 DOI: 10.1016/j.ajem.2020.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Asthma is a common reason for presentation to the Emergency Department and is associated with significant morbidity and mortality. While patients may have a relatively benign course, there is a subset of patients who present in a critical state and require emergent management. OBJECTIVE This narrative review provides evidence-based recommendations for the assessment and management of patients with severe asthma. DISCUSSION It is important to consider a broad differential diagnosis for the cause and potential mimics of asthma exacerbation. Once the diagnosis is determined, the majority of the assessment is based upon the clinical examination. First line therapies for severe exacerbations include inhaled short-acting beta agonists, inhaled anticholinergics, intravenous steroids, and magnesium. Additional therapies for refractory cases include parenteral epinephrine or terbutaline, helium‑oxygen mixture, and consideration of ketamine. Intravenous fluids should be administered, as many of these patients are dehydrated and at risk for hypotension if they receive positive pressure ventilatory support. Noninvasive positive pressure ventilation may prevent the need for endotracheal intubation. If mechanical ventilation is required, it is important to avoid breath stacking by setting a low respiratory rate and allowing permissive hypercapnia. Patients with severe asthma exacerbations will require intensive care unit admission. CONCLUSIONS This review provides evidence-based recommendations for the assessment and management of severe asthma with a focus on the emergency clinician.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Skyler Lentz
- Division of Emergency Medicine, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, United States
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Pennington E, Yaqoob ZJ, Al-Kindi SG, Zein J. Trends in Asthma Mortality in the United States: 1999 to 2015. Am J Respir Crit Care Med 2020; 199:1575-1577. [PMID: 30917289 DOI: 10.1164/rccm.201810-1844le] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Zaid J Yaqoob
- 2 University of Central Florida Orlando, Florida and
| | | | - Joe Zein
- 1 Cleveland Clinic Cleveland, Ohio
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31
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Cremer NM, Baptist AP. Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1294-1301.e7. [PMID: 32035849 DOI: 10.1016/j.jaip.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown. OBJECTIVE To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found. METHODS Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression. RESULTS A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008). CONCLUSIONS Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.
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Affiliation(s)
- Nicole M Cremer
- Division of Internal Medicine, University of Michigan, Ann Arbor, Mich.
| | - Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
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Differences in the Clinical Characteristics of Early- and Late-Onset Asthma in Elderly Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2940296. [PMID: 32090072 PMCID: PMC7014554 DOI: 10.1155/2020/2940296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022]
Abstract
Differences between early-onset and late-onset asthma in elderly subjects have not been comprehensively described in China. We conducted a cross-sectional study to determine the phenotypic differences between early-onset asthma (EOA) and late-onset asthma (LOA) in elderly patients. We collected clinical and physiological data from 176 elderly patients with asthma. Participants were divided into two groups: EOA group and LOA group. Demographics, comorbidities, inflammatory parameters, lung function, severity, asthma control, and medication use among EOA and LOA elderly patients were compared. Elderly subjects with EOA had more atopic disease, a stronger positive family history of asthma, higher IgE, and exhaled nitric oxide levels as compared to those with LOA. In contrast, elderly subjects with LOA had lower lung function and more marked fixed airflow obstruction (FAO). Elderly subjects with LOA had a higher incidence of chronic obstructive pulmonary disease (COPD). No differences were observed in age, gender, BMI, history of smoking, severity, and asthma control between the two groups. Both similarities and differences exist between elderly subjects with EOA and those with LOA in China. Further work is required to determine the pathophysiological, clinical, and therapeutic implications for different asthma phenotypes in elderly subjects.
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Sohn KH, Song WJ, Park JS, Park HW, Kim TB, Park CS, Cho SH. Risk Factors for Acute Exacerbations in Elderly Asthma: What Makes Asthma in Older Adults Distinctive? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:443-453. [PMID: 32141258 PMCID: PMC7061162 DOI: 10.4168/aair.2020.12.3.443] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/01/2019] [Accepted: 12/12/2019] [Indexed: 01/13/2023]
Abstract
Purpose Asthma in the elderly (EA; ≥ 65 years of age) is increasing, adding a heavy socioeconomic burden to the healthcare system. However, little is known about risk factors associated with acute exacerbations in EA patients. The objective of this study was to investigate risk factors for acute exacerbation in EA compared to non-elderly asthma (NEA). Methods We combined data from 3 adult asthma cohorts under a unified protocol and database. Asthmatic patients with regular follow-up during a 1-year period were selected from the cohorts to identify the risk factors predicting acute exacerbations in EA compared to NEA. Results We selected a total of 1,086 patients from the merged cohort. During the observation period, 503 and 583 patients were assigned to the EA and NEA groups, respectively. The exacerbation rate was 31.0% in the EA and 33.2% in the NEA group. Multivariate logistic regression analysis revealed fixed airway obstruction, chronic rhinosinusitis (CRS), and male sex as independent risk factors for exacerbation in the EA group. In the NEA group, exacerbation increased along with an increase in eosinophil count. Bayesian analysis of the interactions among clinical factors revealed that forced expiratory volume in 1 second/forced vital capacity was directly related to exacerbation in the EA group, and eosinophil count was related to exacerbation in the NEA group. Conclusions We suggest that fixed airway obstruction and CRS as the important clinical factors predicting acute exacerbations in EA, whereas in NEA, eosinophil count was the strong predictor of exacerbation.
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Affiliation(s)
- Kyoung Hee Sohn
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Woo Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Sook Park
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Heung Woo Park
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sik Park
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Sohn KH, Song WJ, Kim SH, Jang HC, Kim KW, Chang YS. Chronic cough, not asthma, is associated with depression in the elderly: a community-based population analysis in South Korea. Korean J Intern Med 2019; 34:1363-1371. [PMID: 31610633 PMCID: PMC6823556 DOI: 10.3904/kjim.2018.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Depression and allergic diseases, including asthma, are frequently reported as comorbid conditions. However, their associations have been rarely examined in community-based elderly populations. METHODS The analyses were performed using the baseline data set of the Korean Longitudinal Study of Health and Aging, which consists of 1,000 elderly participants (aged > 65 years) randomly recruited from an urban community. Depression was assessed using the Geriatric Depression Scale, Center for Epidemiologic Studies Depression Scale, and Hamilton Rating Scale for Depression. Major and minor depressive disorders were diagnosed by psychiatrists. Allergic conditions were assessed using structured questionnaires, lung function, and skin prick test. Quality of life and comorbidities were assessed using structured questionnaires. RESULTS Prevalence of asthma and major depressive disorder were 5.4% and 5.3%, respectively. The rate of depression was not significantly different between the non-asthmatic and asthmatic groups. No correlation was observed between the scores obtained using the depression scales and self-reported asthma. However, chronic, frequent, and nocturnal cough were significantly associated with depression and scores obtained using the depression scales, which remained significant in multivariate logistic regression analyses (chronic cough: odds ratio [OR], 3.23; 95% confidence interval [CI], 2.57 to 12.74; p = 0.04). Rhinitis was independently associated with high Mini-Mental State Examination scores (OR, 1.11; 95% CI, 1.05 to 1.17; p < 0.001) and low 36-item short-form (OR, 0.96; 95% CI, 0.80 to 0.98; p = 0.002). CONCLUSION Depression may not be significantly associated with asthma and allergic diseases in elderly populations, but cough is a significant factor affecting depression.
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Affiliation(s)
- Kyoung-Hee Sohn
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Allergy and Immunology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak-Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Yoon-Seok Chang, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7023 Fax: +82-31-716-8349 E-mail:
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35
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Abstract
This review provides an evidence-based guide for the diagnosis, evaluation, and treatment of patients with asthma. It addresses typical questions that arise in the clinic-based care of patients with asthma and provides a basic and comprehensive resource for asthma care.
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36
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Bonomo S, Ferrante G, Palazzi E, Pelosi N, Lirer F, Viegi G, La Grutta S. Evidence for a link between the Atlantic Multidecadal Oscillation and annual asthma mortality rates in the US. Sci Rep 2019; 9:11683. [PMID: 31406172 PMCID: PMC6690970 DOI: 10.1038/s41598-019-48178-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
An association between climatic conditions and asthma mortality has been widely assumed. However, it is unclear whether climatic variations have a fingerprint on asthma dynamics over long time intervals. The aim of this study is to detect a possible correlation between climatic indices, namely the Atlantic Multidecadal Oscillation and Pacific Decadal Oscillation, and asthma mortality rates over the period from 1950 to 2015 in the contiguous US. To this aim, an analysis of non-stationary and non-linear signals was performed on time series of US annual asthma mortality rates, AMO and PDO indices to search for characteristic periodicities. Results revealed that asthma death rates evaluated for four different age groups (5-14 yr; 15-24 yr; 25-34 yr; 35-44 yr) share the same pattern of fluctuation throughout the 1950-2015 time interval, but different trends, i.e. a positive (negative) trend for the two youngest (oldest) categories. Annual asthma death rates turned out to be correlated with the dynamics of the AMO, and also modulated by the PDO, sharing the same averaged ∼44 year-periodicity. The results of the current study suggest that, since climate patterns have proved to influence asthma mortality rates, they could be advisable in future studies aimed at elucidating the complex relationships between climate and asthma mortality.
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Affiliation(s)
- Sergio Bonomo
- Istituto per la Ricerca e l'Innovazione Biomedica, National Research Council (CNR-IRIB), Via Ugo La Malfa 153, 90146, Palermo, Italy
- Institute for Marine Sciences, National Research Council (CNR-ISMAR), Calata Porta di Massa, 80133, Napoli, Italy
- National Institute of Geophysics and Volcanology (INGV), Via della Faggiola 32, 52126, Pisa, Italy
| | - Giuliana Ferrante
- Dipartimento di Scienze per la Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Elisa Palazzi
- Institute of Atmospheric Sciences and Climate, National Research Council (CNR-ISAC), Corso Fiume 4, I-10133, Torino, Italy
| | - Nicola Pelosi
- Institute for Marine Sciences, National Research Council (CNR-ISMAR), Calata Porta di Massa, 80133, Napoli, Italy
| | - Fabrizio Lirer
- Institute for Marine Sciences, National Research Council (CNR-ISMAR), Calata Porta di Massa, 80133, Napoli, Italy
| | - Giovanni Viegi
- Istituto per la Ricerca e l'Innovazione Biomedica, National Research Council (CNR-IRIB), Via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Stefania La Grutta
- Istituto per la Ricerca e l'Innovazione Biomedica, National Research Council (CNR-IRIB), Via Ugo La Malfa 153, 90146, Palermo, Italy
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37
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Omalizumab Treatment Patterns Among Patients with Asthma in the US Medicare Population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:507-515.e10. [PMID: 31336178 DOI: 10.1016/j.jaip.2019.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asthma in older adults is associated with high rates of morbidity and mortality; similarly, asthma can be severe enough among younger adults to warrant disability benefits. Reasons for poor outcomes in both groups of patients may include discontinuation and lack of adherence to controller therapies. OBJECTIVE To examine characteristics and treatment patterns of US Medicare patients initiating omalizumab for asthma, and factors associated with its discontinuation and adherence. METHODS A retrospective claims database analysis of Medicare beneficiaries with asthma initiating omalizumab treatment was carried out. The primary outcomes were omalizumab discontinuation (gap in use ≥90 days) and adherence (proportion of days covered ≥0.8) over a 12-month follow-up. Multivariable regressions were used to examine factors associated with omalizumab discontinuation and adherence. RESULTS Of the 3058 Medicare patients initiating omalizumab for asthma (mean age, 62.7 years), 36.9% discontinued omalizumab and 60.6% were adherent. Discontinuation rates were 32.7% and 42.8%, and adherence rates were 65.4% and 53.9%, for disabled and older Medicare patients, respectively. Patients aged 65 to 69 years and 70 to 74 years had significantly lower odds of discontinuation (odds ratios [95% CI], 0.66 [0.46-0.93] and 0.62 [0.43-0.89], respectively) and higher odds of adherence than did patients aged 80 years or older. Compared with patients receiving low-income subsidy, patients not receiving low-income subsidy had lower odds of discontinuation (0.66 [0.52-0.83]) and higher odds of adherence (1.52 [1.20-1.93]). Greater numbers of preindex evaluation and management physician visits and comorbid rhinitis were associated with lower odds of discontinuation and higher odds of adherence. CONCLUSIONS More than 60% of Medicare patients with asthma continued and were adherent to omalizumab over a 12-month follow-up. Patient age, low-income subsidy status, and the numbers of evaluation and management physician visits were among factors associated with treatment adherence and discontinuation.
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38
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A Comparison of Leukotriene Receptor Antagonists to Low-Dose Inhaled Corticosteroids in the Elderly with Mild Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2642-2652.e3. [PMID: 31108218 DOI: 10.1016/j.jaip.2019.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although elderly patients with asthma have clinical characteristics different from those of young adults, few studies or guidelines have focused on specific treatments for this population. OBJECTIVE This study compared the effectiveness of leukotriene receptor antagonists (LTRAs) versus inhaled corticosteroids (ICSs) in elderly patients with asthma in real-world settings. METHODS We extracted records for elderly patients with asthma who were newly prescribed LTRAs or low-dose ICSs from January 2003 to December 2010 from National Sample Cohort data of Korea. We defined the first prescription date for each medication as the index date. We compared the risks of asthma exacerbation between the 2 groups using Cox proportional-hazard regression after propensity score-based inverse probability of treatment weighting to balance covariates between treatment groups. We also compared asthma-related health care resource utilization and medication compliance in both groups using chi-square test and t test. RESULTS The number of identified patients newly treated with LTRAs and low-dose ICSs was 1571 and 121, respectively. The risks of asthma exacerbation in the LTRA and low-dose ICS groups after weighting were not significantly different (hazard ratio, 0.98; 95% CI, 0.65-1.54). The proportion with high compliance (medication possession ratio ≥ 80%) in the LTRA group was higher than that in the low-dose ICS group. CONCLUSIONS The effectiveness of LTRAs was not different from that of low-dose ICSs regarding the risk of asthma exacerbation in elderly patients with asthma in real-world settings. Given the practical benefits gained from convenient administration, LTRAs can be considered a reasonable alternative first-line therapy for elderly patients with mild asthma.
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39
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Morty RE, Prakash YS. Senescence in the lung: is this getting old? Am J Physiol Lung Cell Mol Physiol 2019; 316:L822-L825. [PMID: 30892079 DOI: 10.1152/ajplung.00081.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rory E Morty
- Department of Internal Medicine, Justus-Liebig-Universität Gießen, Giessen, Germany.,Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research , Bad Nauheim , Germany
| | - Y S Prakash
- Department of Anesthesiology, Mayo Clinic , Rochester, Minnesota.,Department of Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
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40
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Yuan L, Du X, Tang S, Wu S, Wang L, Xiang Y, Qu X, Liu H, Qin X, Liu C. ITGB4 deficiency induces senescence of airway epithelial cells through p53 activation. FEBS J 2019; 286:1191-1203. [PMID: 30636108 DOI: 10.1111/febs.14749] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/20/2018] [Accepted: 01/10/2019] [Indexed: 12/29/2022]
Abstract
Aging is characterized by a progressive loss of physiological integrity, leading to impaired organ function and, ultimately, increased vulnerability to death. Many complex diseases are related to aging, including asthma. In the lung, the airway epithelium serves as the first barrier to prevent the access of inspired external stimuli and dictates the initial stress responses. Notably, in the airway mucosa of asthma patients, an increase in senescent airway epithelial cells has been detected. Although it has been speculated that the senescence of airway epithelial cells could increase asthma susceptibility and aggravate asthma severity, the role of cell senescence in the development of asthma remains unclear. Integrin β4 (ITGB4) is a structural adhesion molecule with complex physiological functions that is downregulated in airway epithelial cells of asthma patients. This study demonstrates that the expression of ITGB4 in airway epithelial cells is downregulated significantly under oxidative stress or upon inflammatory stimulation. Moreover, we show that ITGB4 deficiency induces the senescence of airway epithelial cells through the activation of the p53 pathway both in vitro and in vivo. Together, our results demonstrate that airway epithelial senescence induced by ITGB4 deficiency after oxidative stress or inflammatory stimulation may be involved in the pathogenesis of asthma. Understanding the contribution of ITGB4 deficiency to the senescence of airway epithelial cells in asthma patients may provide new therapeutic approaches for the treatment of asthma.
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Affiliation(s)
- Lin Yuan
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Xizi Du
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Sha Tang
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Shuangyan Wu
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Leyuan Wang
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Yang Xiang
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiangping Qu
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Huijun Liu
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoqun Qin
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Chi Liu
- Department of Physiology, Xiangya School of Medicine, Central South University, Changsha, China
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41
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Zein JG, Denson JL, Wechsler ME. Asthma over the Adult Life Course: Gender and Hormonal Influences. Clin Chest Med 2018; 40:149-161. [PMID: 30691709 DOI: 10.1016/j.ccm.2018.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asthma is a common disorder that affects genders differently across the life span. Earlier in life, it is more common in boys. At puberty, asthma becomes more common and often more severe in girls and women. The effect of sex hormones on asthma incidence and its severity is difficult to differentiate from other asthma severity risk factors, such as racial background, socioeconomic factors, obesity, atopy, environmental exposure, and, in particular, lung aging. Recognizing gender-associated and age-associated differences is important to understanding the pathobiology of asthma and to providing effective education and personalized care for patients with asthma across the life course.
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Affiliation(s)
- Joe G Zein
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44106, USA
| | - Joshua L Denson
- National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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42
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Quan-San Z, Xiaohong X, Ying L, Zhaojia S. Role of Th17-cell related cytokines in geriatric asthma. J Int Med Res 2018; 47:580-590. [PMID: 30304965 PMCID: PMC6381488 DOI: 10.1177/0300060518803828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the pathogenesis of geriatric asthma through immunoglobulin E (IgE), interleukin-17A (IL-17A), IL-17F, and glucocorticoid receptor-β (GR-β) expression. METHODS We studied 51 geriatric male patients with asthma and 50 young male patients with asthma. We also included 21 normal geriatric males and 21 normal young males. All geriatric and young patients were divided into groups according to pulmonary function. Levels of cytokines, such as IgE, IL-17A, IL-17F, and GR-β, were measured. Pulmonary function was assessed. The results from patients were compared with those from the 42 healthy subjects. RESULTS Serum IgE, IL-17A, IL-17F, and GR-β levels in geriatric patients with moderate or severe asthma were significantly higher than those in young patients with moderate asthma and in the normal population. Geriatric patients with asthma had higher asthma control test scores than did young patients with asthma. CONCLUSION Hormone resistance in geriatric male patients with asthma is more serious than that in young male patients with asthma. Airway inflammation and airway remodeling in geriatric male patients with asthma may be more serious than those in young male patients with asthma, even when there is similar pulmonary function.
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Affiliation(s)
- Zhang Quan-San
- Qingdao Municipal Hospital Group Emergency Department, Qingdao, China
| | - Xu Xiaohong
- Qingdao Municipal Hospital Group Emergency Department, Qingdao, China
| | - Li Ying
- Qingdao Municipal Hospital Group Emergency Department, Qingdao, China
| | - Sun Zhaojia
- Qingdao Municipal Hospital Group Emergency Department, Qingdao, China
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43
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Veeranki SP, Sharma K, Ohabughiro MU, Mehta HB, Adhikari D, Kuo YF, Calhoun WJ. 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbations: Insights From the Nationwide Readmission Database. Chest 2018; 150:1162-1165. [PMID: 27832886 DOI: 10.1016/j.chest.2016.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
| | - Kanika Sharma
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, LA
| | | | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Deepak Adhikari
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - William J Calhoun
- Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
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44
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Sundaresan AS, Schneider G, Reynolds J, Kirchner HL. Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data. Appl Clin Inform 2018; 9:528-540. [PMID: 30040112 PMCID: PMC6051766 DOI: 10.1055/s-0038-1666994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background
Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome.
Objective
We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population.
Methods
We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset.
Results
There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms.
Conclusion
We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes.
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Affiliation(s)
- Agnes S Sundaresan
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, United States.,Medicine Institute, Geisinger Health System, Danville, Pennsylvania, United States
| | - Gargi Schneider
- MedPeds Program, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Joy Reynolds
- Lewis Katz School of Medicine at Temple University, Temple University, Philadelphia, Pennsylvania, United States
| | - H Lester Kirchner
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States.,Department of Clinical Sciences, Geisinger Commonwealth School of Medicine, Geisinger Health System, Scranton, Pennsylvania, United States.,Department of Pediatrics, Global and Immigrant Health Section, Baylor College of Medicine, Houston, Texas, United States
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Gemicioglu B, Bayram H, Cimrin A, Abadoglu O, Cilli A, Uzaslan E, Gunen H, Akyildiz L, Suerdem M, Ozlu T, Misirligil Z. Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey. J Asthma 2018; 56:553-561. [PMID: 29714602 DOI: 10.1080/02770903.2018.1471707] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients. METHODS This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months. RESULTS Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly. CONCLUSIONS Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.
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Affiliation(s)
- Bilun Gemicioglu
- a Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Hasan Bayram
- b Department of Pulmonary Diseases, Koç University , Medical School
| | - Arif Cimrin
- c Department of Pulmonary Diseases, Faculty of Medicine , Dokuz Eylul University , Izmir , Turkey
| | - Oznur Abadoglu
- d Department of Pulmonary Diseases, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Aykut Cilli
- e Department of Pulmonary Diseases, Faculty of Medicine , Akdeniz University , Antalya , Turkey
| | - Esra Uzaslan
- f Department of Pulmonary Diseases, Faculty of Medicine , Uludag University , Bursa , Turkey
| | - Hakan Gunen
- g Department of Pulmonary Diseases , Sureyyapasa Pulmonary Diseases Hospital and Research Center , Istanbul , Turkey
| | - Levent Akyildiz
- h Department of Pulmonary Diseases , Memorial Dicle Hospital , Diyarbakir , Turkey
| | - Mecit Suerdem
- i Department of Pulmonary Diseases, Faculty of Medicine , Selcuk University , Konya , Turkey
| | - Tevfik Ozlu
- j Department of Pulmonary Diseases, Faculty of Medicine , Karadeniz Teknik University , Trabzon , Turkey
| | - Zeynep Misirligil
- k Department of Pulmonary Diseases, Faculty of Medicine , Ankara University , Ankara , Turkey
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The impact of patient autonomy on older adults with asthma. Ann Allergy Asthma Immunol 2018; 121:65-68.e1. [PMID: 29730013 DOI: 10.1016/j.anai.2018.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Understanding patient preferences and desire for involvement in making medical decisions is important when managing chronic conditions. Previous studies have used the Autonomy Preference Index (API) in younger patients with asthma to evaluate these preferences. OBJECTIVE To identify factors associated with autonomy and to determine whether autonomy is related to asthma outcomes among older adults. METHODS A total of 189 older adults (>55 years old) with persistent asthma were included. Preferences for autonomy were assessed using the API, with a higher score indicating higher desire for autonomy. Scores were separated into 2 domains of information-seeking and decision-making preferences. The separated scores were correlated with asthma outcomes and demographic variables. To control for confounding factors, a linear regression analysis was performed. RESULTS Higher decision-making preference scores correlated with female sex (P = .007), higher educational level (P = .01), and lower depression scores (P = .04). Regarding outcomes, decision-making scores positively correlated with Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) scores (P = .01). On linear regression analysis, the Mini-AQLQ score remained significantly associated with decision-making preference scores (P = .03). There was no association with asthma control test scores, spirometry values, and health care use. Information-seeking preference scores correlated with educational level (P = .03), but there was no correlation with asthma outcomes. CONCLUSION Older adults with asthma and a greater desire for involvement in decision making have better asthma-related quality of life. Future studies with the intention to increase patient autonomy may help establish a causal relationship.
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Tanaka H, Nakatani E, Fukutomi Y, Sekiya K, Kaneda H, Iikura M, Yoshida M, Takahashi K, Tomii K, Nishikawa M, Kaneko N, Sugino Y, Shinkai M, Ueda T, Tanikawa Y, Shirai T, Hirabayashi M, Aoki T, Kato T, Iizuka K, Fujii M, Taniguchi M. Identification of patterns of factors preceding severe or life-threatening asthma exacerbations in a nationwide study. Allergy 2018; 73:1110-1118. [PMID: 29197099 PMCID: PMC6668009 DOI: 10.1111/all.13374] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reducing near-fatal asthma exacerbations is a critical problem in asthma management. OBJECTIVES To determine patterns of factors preceding asthma exacerbations in a real-world setting. METHODS In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the 2-week period before admission. RESULTS Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low Body mass index and tendency to depression who had stopped anti-asthma medications, smoked, and hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly rapid worsening within 48 hours, mostly middle-aged and older, relatively good inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist (LABA) compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these 3 clusters. CONCLUSION To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increase usual therapy, or new anti-type 2 response-targeted therapies should be considered for cluster C.
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Affiliation(s)
- H. Tanaka
- NPO Sapporo Cough Asthma, and Allergy CenterSapporoJapan
- Formerly at the Department of Respiratory Medicine and AllergologySapporo Medical University School of MedicineSapporoJapan
| | - E. Nakatani
- Translational Research Informatics CenterFoundation for Biomedical Research and InnovationKobeJapan
- Department of Biostatistics and Data ScienceOsaka University Graduate School of MedicineSuitaJapan
| | - Y. Fukutomi
- Clinical Research Center for Allergology and RheumatologySagamihara National HospitalSagamiharaJapan
| | - K. Sekiya
- Clinical Research Center for Allergology and RheumatologySagamihara National HospitalSagamiharaJapan
| | - H. Kaneda
- Department of Biostatistics and Data ScienceOsaka University Graduate School of MedicineSuitaJapan
| | - M. Iikura
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - M. Yoshida
- Division of Respiratory MedicineNational Hospital Organization Fukuoka HospitalFukuokaJapan
| | - K. Takahashi
- Department of Respiratory Diseases and Chest SurgeryOtsu Red Cross HospitalOtsuJapan
| | - K. Tomii
- Department of Respiratory MedicineKobe City Medical Center General HospitalKobeJapan
| | - M. Nishikawa
- Department of Respiratory MedicineFujisawa City HospitalFujisawaJapan
| | - N. Kaneko
- Department of Pulmonary MedicineKameda Medical CenterKamogawaJapan
| | - Y. Sugino
- Department of Respiratory MedicineToyota Memorial HospitalToyotaJapan
| | - M. Shinkai
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - T. Ueda
- The Department of Respiratory MedicineSaiseikai Nakatsu HospitalOsakaJapan
| | - Y. Tanikawa
- Department of Respiratory Medicine and Clinical ImmunologyToyota Kosei HospitalToyotaJapan
| | - T. Shirai
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
| | - M. Hirabayashi
- Department of Respiratory DiseasesAmagasaki General Medical CenterAmagasakiJapan
| | - T. Aoki
- Department of Internal Medicine, Respiratory DivisionTokai University School of MedicineIseharaJapan
| | - T. Kato
- Department of Respiratory Medicine and AllergologyKariya Toyota General HospitalKariyaJapan
| | - K. Iizuka
- Internal MedicinePublic Tomioka General HospitalTomiokaJapan
| | - M. Fujii
- Formerly at the Department of Respiratory Medicine and AllergologySapporo Medical University School of MedicineSapporoJapan
| | - M. Taniguchi
- Clinical Research Center for Allergology and RheumatologySagamihara National HospitalSagamiharaJapan
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Altawalbeh SM, Thorpe CT, Zgibor JC, Kane-Gill S, Kang Y, Thorpe JM. Economic Burden Associated with Receiving Inhaled Corticosteroids with Leukotriene Receptor Antagonists or Long-Acting Beta Agonists as Combination Therapy in Older Adults. J Manag Care Spec Pharm 2018; 24:478-486. [PMID: 29694289 PMCID: PMC7977940 DOI: 10.18553/jmcp.2018.24.5.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a paucity of literature on the health care expenditures associated with different pharmacologic treatments in older adults with asthma that is not well controlled on inhaled corticosteroids (ICS). OBJECTIVE To compare asthma-related and all-cause health care expenditures associated with leukotriene receptor antagonists (LTRA) versus long-acting beta agonists (LABA) when added to ICS in older adults with asthma. METHODS A retrospective cohort was constructed using 2009-2010 Medicare fee-for-service medical and pharmacy claims from a 10% random sample of beneficiaries continuously enrolled in Parts A, B, and D in 2009. The sample comprised patients who were aged 65 years and older, diagnosed with asthma, and treated exclusively with ICS + LABA or ICS + LTRA. Outcomes assessed were asthma-related expenditures (medical, pharmacy, and total) and all-cause health care expenditures (medical, pharmacy, and total). Outcomes were measured from the date of the first prescription for the add-on treatment (LABA or LTRA in combination with ICS) after having at least a 4-month "wash-in" period in which patients were receiving no controller, ICS alone, or ICS plus the add-on treatment of the follow-up period. Patients were followed until death, switching to or adding the other add-on treatment, or the end of the study (December 31, 2010). Multivariable regression models with nonparametric bootstrapped standard errors were used to compare all-cause and asthma-related expenditures per patient per month (PPPM) between ICS + LABA and ICS + LTRA users. All models were adjusted for demographics, comorbidities, and county-level health care access variables. RESULTS The primary analysis included 14,702 patients, of whom 12,940 were treated with ICS + LABA and 1,762 were treated with ICS + LTRA. The mean (SD) follow-up periods were 12.3 (± 5.7) months for the ICS + LABA group and 15.3 (± 5.1) months for the ICS + LTRA group. Adjusted asthma-related expenditures PPPM were $400 for the ICS + LTRA group compared with $286 for the ICS + LABA group (P < 0.001). However, adjusted total all-cause expenditure PPPM was significantly lower for patients treated with ICS + LTRA ($6,087 for ICS + LTRA compared with $6,975 for ICS + LABA, P = 0.029). CONCLUSIONS Older adults with asthma often experience economic burden from asthma and other chronic illnesses. Compared with ICS + LTRA, ICS + LABA was associated with lower asthma-related expenditures but with higher all-cause expenditures in older adults. DISCLOSURES Support for this study was provided by the University of Pittsburgh School of Pharmacy and the Pittsburgh Claude D. Pepper Older Americans Independence Center (NIA P30 AGAG024827). C. Thorpe reports grants from the National Institute of Aging during the conduct of this study. The other authors have nothing to disclose.
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Affiliation(s)
- Shoroq M. Altawalbeh
- Department of Clinical Pharmacy, Jordan University of Science and Technology School of Pharmacy, Irbid, Jordan, and Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Carolyn T. Thorpe
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Janice C. Zgibor
- Department of Epidemiology and Biostatistics, University of South Florida College of Public Health, Tampa
| | - Sandra Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Yihuang Kang
- Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Joshua M. Thorpe
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Bennett GH, Carpenter L, Hao W, Song P, Steinberg J, Baptist AP. Risk factors and clinical outcomes associated with fixed airflow obstruction in older adults with asthma. Ann Allergy Asthma Immunol 2018; 120:164-168.e1. [PMID: 29290515 PMCID: PMC5803342 DOI: 10.1016/j.anai.2017.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma. OBJECTIVE To identify risk factors and outcomes related to FAO in older adults with asthma. METHODS Subjects older than 55 years with a physician diagnosis of persistent asthma were evaluated. Collected data included participant demographic information, medications, asthma exacerbations, Asthma Control Test (ACT) score, Asthma Quality of Life (AQLQ) score, comorbidities, spirometry, atopic status, and fractional exhaled nitric oxide. Clinical characteristics and outcomes associated with FAO (defined as post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity ≤70%) were assessed. RESULTS A total of 186 participants were analyzed (48 men and 138 women, mean age 66 years). FAO was demonstrated in 30% of participants. Using regression analysis, predictors of FAO included advanced age, African American race, male sex, and longer duration of asthma. In outcomes analysis, FAO was associated with worsened ACT and AQLQ scores; however, after controlling for confounding factors, logistic regression showed no association. No significant association was found between FAO and exacerbations, fractional exhaled nitric oxide, atopy, rhinitis, education level, depression, smoking, or body mass index. CONCLUSION Risk factors associated with FAO in older adults with asthma include advanced age, African American race, increased asthma duration, and male sex. Unlike younger patients, FAO is not independently associated with worsened asthma control, quality of life, or exacerbations in older patients with asthma. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01979055.
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Affiliation(s)
- Gregory H Bennett
- Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Michigan.
| | - Laurie Carpenter
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Wei Hao
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Peter Song
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Joel Steinberg
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Michigan; University of Michigan School of Public Health, Ann Arbor, Michigan
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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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