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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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Al-Moamary MS, Alhaider SA, Allehebi R, Idrees MM, Zeitouni MO, Al Ghobain MO, Alanazi AF, Al-Harbi AS, Yousef AA, Alorainy HS, Al-Hajjaj MS. The Saudi initiative for asthma - 2024 update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2024; 19:1-55. [PMID: 38444991 PMCID: PMC10911239 DOI: 10.4103/atm.atm_248_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 03/07/2024] Open
Abstract
The Saudi Initiative for Asthma 2024 (SINA-2024) is the sixth version of asthma guidelines for the diagnosis and management of asthma for adults and children that was developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up-to-date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA Panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5-12 years, and children aged <5 years. SINA guidelines have focused more on personalized approaches reflecting a better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.
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Affiliation(s)
- Mohamed Saad Al-Moamary
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A. Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riyad Allehebi
- Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majdy M. Idrees
- Department of Medicine, Respiratory Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed O. Al Ghobain
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah F. Alanazi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Adel S. Al-Harbi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan S. Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Paediatrics, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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3
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Zhu H, Huang Z, Liu T, An N, Gan H, Huang D, Hao C, Luo W, Sun B. Sensitization to Furry Animals in Patients with Suspected Allergic Disease in China: A Multicenter Study. J Asthma Allergy 2022; 15:1701-1712. [PMID: 36452936 PMCID: PMC9704004 DOI: 10.2147/jaa.s390473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 08/30/2023] Open
Abstract
PURPOSE An objective of this study was to investigate the allergen sensitization characteristics of cat, dog and horse dander in patients with suspected allergic diseases in different geographical regions of Chinese mainland. PATIENTS AND METHODS We invited 2377 patients aged 0-86 years with suspected allergic diseases to participate in a cross-sectional survey in 11 provinces in China. Combined with the questionnaires and animal-specific IgE levels, we analyzed the epidemiological characteristics and risk factors of furry animal sensitization in different regions and populations of Chinese Mainland. RESULTS Among the 2377 patients with suspected allergic diseases, 14.9% were sensitized to cat dander, 9.3% to dog dander and 5.5% to horse dander. Animal allergens mainly cause low-level sensitization (class 1-3). There was a significant correlation between cat, dog and horse dander allergen sIgE, with correlation coefficients (rs) all greater than 0.750. The majority (46.5%) of sIgE-positive patients were sensitized to at least two animal allergens simultaneously. The prevalence of these animals all showed a trend of increasing first and then decreasing with age, and all reached the peak in young adolescence. As for the geographical factors, the sensitization rate of cats and dogs in Western was significantly higher than that in Eastern (cat: 18.4% vs 9.2%, dog: 11.6% vs 5.5%, all P < 0.001), however, no significant differences were found in horses. Aged ≤6 years, living in Western, and high animal allergen exposure elevated the risk of cat or dog sensitization. Living on a lower floor (aOR: 0.56) was a protective factor for horse sensitization. CONCLUSION In this representative sample of Chinese patients with suspected allergic diseases, there was an apparent geographic variation in sensitization to cats and dogs. Age factor and living in Western also had a significant impact on animal allergen sensitization rate.
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Affiliation(s)
- Huiqing Zhu
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
| | - Zhifeng Huang
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
| | - Tingting Liu
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
| | - Nairui An
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
| | - Hui Gan
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
| | - Dongming Huang
- Department of Pediatrics, Boai Hospital of Zhongshan City, Zhongshan, 528400, People’s Republic of China
| | - Chuangli Hao
- Department of Respirology, Children’s Hospital, Soochow University, Suzhou, 215025, People’s Republic of China
| | - Wenting Luo
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Department of Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China
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4
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Abstract
The lungs are continually subjected to noxious and inert substances, are immunologically active, and are in a constant state of damage and repair. This makes the pulmonary system particularly vulnerable to diseases of aging. Aging can be understood as random molecular damage that is unrepaired and accumulates over time, resulting in cellular defects and tissue dysfunction. The breakdown of cellular mechanisms, including stem cell exhaustion, genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, altered intercellular communication, and changes in the extracellular matrix is thought to advance the aging process itself. Chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and cancers illustrate a pathologic breakdown in these mechanisms beyond normal aging. The immune system becomes less effective with advancing age. There is a low-level state of chronic inflammation termed inflammaging which is thought to be driven by immunosenescence, the changes in the innate and adaptive immune systems with advancing age that lead to dysregulation and decreased effectiveness of the immune system. These processes of aging lead to expected changes in the form and function of the respiratory system, most notably a loss of lung elasticity, decrease in respiratory muscle strength, increase in ventilation-perfusion mismatching, and stiffening of the vasculature. The astute clinician is aware of these expected findings and does not often attribute dyspnea to aging alone. Maintaining a low threshold to investigate for comorbid disease and understanding how pulmonary disease presents differently in the elderly than in younger adults can improve clinical outcomes. © 2022 American Physiological Society. Compr Physiol 12:3509-3522, 2022.
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Affiliation(s)
- Julia Budde
- New York City Health and Hospitals/Metropolitan Hospital, New York, New York, USA
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5
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Panettieri RA, Chupp G. TENOR Revisited. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2254-2255. [PMID: 32620435 DOI: 10.1016/j.jaip.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ.
| | - Geoffrey Chupp
- Yale Center for Asthma and Airways Disease, Yale University, New Haven, CT
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6
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Clinical Differences between Early- and Late-Onset Asthma: A Population-Based Cross-Sectional Study. Can Respir J 2021; 2021:8886520. [PMID: 33574971 PMCID: PMC7864752 DOI: 10.1155/2021/8886520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background Limited information exists about the nature of late-onset asthma (LOA) without medication intervention when compared to early-onset asthma (EOA). Our goal was to understand how EOA and LOA affect clinical and pathophysiological features. Methods A population-based cross-sectional study was carried out in Zhongshan Hospital (Shanghai, China). EOA and LOA were based on age of diagnosis (before and after age 40 years, respectively). Clinical variables were collected with an emphasis on allergic features, analyzed, related, and compared using one-way ANOVA or Kruskal-Wallis test. Correlations between blood basophils and clinical data were evaluated by Spearman's rank test. Statistical analyses were conducted with SPSS v24.0. Results Of a total of 12,760 adults with cough, sputum, or chest tightness, 90 subjects with EOA (mean age ± standard deviation (SD):28.73 ± 5.89), 111 with LOA (mean age ± SD: 60.25 ± 9.85), and 106 with chronic obstructive pulmonary disease (COPD) (mean age ± SD: 61.58 ± 10.95) were selected. FEV1/FVC (%), FEV1% predicted, and FVC% predicted were all significantly lower in LOA compared to EOA (p < 0.01). The values of post-bronchodilator FEV1 in bronchodilator reversibility testing were higher in the LOA and EOA groups compared to subjects with COPD (p < 0.01). Among allergic features, mite sensitization was most common in EOA patients, followed by LOA and COPD, whereas mold sensitization was more prevalent in LOA than EOA. Moreover, blood eosinophils were a typical feature of asthma in both EOA and LOA compared to COPD and controls (p < 0.01), and there were no differences in blood neutrophils in LOA compared to controls. Interestingly, blood basophils were increased in both EOA (p < 0.01) and LOA (p < 0.05) compared to COPD and controls. This variable correlated with eosinophils in EOA (r = 0.549, p=0.002) but not in LOA. Conclusion LOA is a distinct clinical entity from EOA. In LOA, atopy was less frequent and spirometry values were lower when compared to EOA. In EOA, blood basophils and eosinophils were significantly correlated owing to pathophysiological differences between the two forms of the disease.
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7
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Federman AD, Thanik E, O'Conor R, Arora A, Wolf MS, Wisnivesky JP. Patient characteristics associated with improvements in asthma control and reduction in emergency department visits for older adults with asthma. J Asthma 2020; 58:1528-1535. [PMID: 32812836 DOI: 10.1080/02770903.2020.1805753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify patient characteristics associated with improvements in asthma control among older adults with asthma. METHODS Secondary analysis of data from a randomized controlled trial of an asthma self-management support intervention for adults ages 60 and older with moderate-severe persistent asthma (n = 391). We tested the association of baseline patient characteristics with reduced emergency department (ED) visits and improvement in asthma control equal to or exceeding the minimal clinically important difference (MCID) in asthma control test (ACT) scores (3.0) 12 months. RESULTS At baseline, the mean age was 68 years, 15.0% were male, 30.3% were black, and 56.5% were Hispanic. Patients with a history of ED visits in the 12 months preceding study enrollment were significantly more likely to experience an ED visit during the study period (adjusted odds ratio [AOR] 6.92, 95% confidence interval [CI] 2.18-21.9, p < .0001). Similarly, those with poorer asthma control (baseline ACT scores <13) had greater odds of achieving improved asthma control (AOR 13.7, 95% CI 5.32-35.1, p < .0001). No other variables had statistically significant associations with the outcomes. CONCLUSIONS Low scores on the asthma control test and prior ED visits for asthma are strong correlates of later clinically meaningful changes in asthma control among older adults. Health systems preparing for population management of patients with asthma ought to consider incorporating serial collection of data on the ACT into the monitoring and management of older asthmatics, a high-risk patient population.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Arushi Arora
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Albataineh E, Al-Zayadneh E, Al-Shagahin H, AL Soloman A, Altarawneh A, Aldmour I. Asthma Control and Its Predictive Factors in Adult Asthma Patients. J Clin Med Res 2019; 11:807-817. [PMID: 31803325 PMCID: PMC6879035 DOI: 10.14740/jocmr4021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Asthma is a highly prevalent condition that remains difficult to control, as its associated factors remain poorly understood. Thus, the primary aim of the present investigation was to determine the prevalence of uncontrolled asthma in hospital units in south Jordan and to evaluate the risk factors that may contribute to uncontrolled asthma. METHODS This was a cross-sectional study involving 93 patients aged 40.5 ± 13.6 years that met the criteria of the Global Initiative for Asthma (GINA). Relevant patient data were collected via a questionnaire and through a review of medical records. The questionnaire comprised of sections pertaining to sociodemographic and clinical characteristics, as well as pharmacological asthma treatment, asthma severity and asthma control. Asthma severity was determined in line with the GINA guidelines, whereby the patients were classified into four groups (intermittent, mild persistent, moderate persistent or severe persistent). Moreover, based on the findings yielded by the asthma control questionnaire (ACQ), patients were divided into three levels, whereby those diagnosed with partly controlled and uncontrolled asthma were combined into one group, denoted as "poorly controlled asthma", with "uncontrolled asthma" and "controlled asthma" as the remaining two groups. Atopy was defined as one or more positive reactions (A/H ratio > 1) on a skin prick test. RESULTS Asthma control was achieved in 45.2% of the sample. Moreover, older age, severe asthma according to the GINA guidelines, longer duration of asthma, atopy, being on treatment for asthma and history of allergic rhinitis were identified as the main risk factors contributing to poorly controlled asthma. Multivariate analyses, however, revealed that only atopy to two or more allergens and having severe asthmatic attacks were statistically significantly associated with poorly controlled asthma, for which the odds ratio Mantel-Haenszel (ORMH) of 17.2 and 2.2 was obtained, respectively. CONCLUSION Our findings indicate that severe asthma and atopy to two or more allergens are the main risk factors for uncontrolled asthma. However, further studies with larger sample sizes are needed to confirm these results.
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Affiliation(s)
- Eman Albataineh
- Department of Microbiology and Immunology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Enas Al-Zayadneh
- Department of Pediatrics, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Hani Al-Shagahin
- Department of Special Surgery, Faculty of Medicine, Mutah University, Al-Karak, Jordan
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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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Puente-Maestu L, Llanos Flores M, Benedetti P, Frías Benzant I, Oliva Ramos A, García de Pedro J, Sanz Sanz P, García-López J. Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain. Biomed Hub 2018; 3:1-9. [PMID: 31988961 PMCID: PMC6945925 DOI: 10.1159/000492075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. Objectives The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. Methods Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. Results Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. Conclusions BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.
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Affiliation(s)
- Luis Puente-Maestu
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Milagros Llanos Flores
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Paola Benedetti
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Ingrid Frías Benzant
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain
| | - Alicia Oliva Ramos
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Julia García de Pedro
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Pilar Sanz Sanz
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain
| | - Javier García-López
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
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11
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Budde J, Skloot GS. Is aging a "comorbidity" of asthma? Pulm Pharmacol Ther 2018; 52:52-56. [PMID: 29981459 DOI: 10.1016/j.pupt.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 01/27/2023]
Abstract
The aging population is growing at an unparalleled rate. Asthma is common in the elderly (age over 65 years) and can be more severe with little chance for remission. Asthma in older individuals is often under-diagnosed, misdiagnosed and frequently under-treated. Concomitant medical and psychosocial conditions are more prevalent in the elderly and can obfuscate the presentation of asthma and make it more difficult to assess and manage. While these comorbidities are important in understanding elderly asthma, aging itself can be considered a "comorbidity" since it impacts structural and functional changes in the lung. Structural changes of the aging lung may worsen physiologic function in asthma. The immune system also changes with age, with increased vulnerability to pathogens and differences in airway inflammation, leading to variability in how asthma manifests and responds to treatment. The fact that aging can influence the severity and presentation of asthma along with its diagnosis and management is important for the treating physician to understand. This article will discuss the multitude of factors that justify considering aging as a comorbidity of asthma.
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Affiliation(s)
- Julia Budde
- Division of Pulmonary, Critical Care, & Sleep Medicine Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building 5th Floor, Room 5-20, New York, NY, 10029, USA.
| | - Gwen S Skloot
- Division of Pulmonary, Critical Care, & Sleep Medicine Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building 5th Floor, Room 5-20, New York, NY, 10029, USA.
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12
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Abstract
Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non-Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FENO). As non-Th2-LOA is often resistant to corticosteroids, this phenotype often requires another treatment strategy such as macrolide, diet, or smoking cessation. We often struggle with the management of LOA patients due to a lack of evidence; therefore, the elucidation of the mechanism of LOA contributes to increased efficiency of diagnosis and treatment of LOA. Age-related immune system and structural changes are thought to be associated with the pathophysiology of LOA. In the former case, changes in inflammatory cell function such as variations in the innate immune response and acquisition of autoimmunity or upregulation of oxidative stress are thought to be involved in the mechanism. Meanwhile, the latter can also become triggers or exacerbating factors of LOA via enhancement of airway hyperresponsiveness, decline in lung function, increased air trapping, and reduction in chest wall compliance. Therefore, appropriate individualized management in LOA may be possible through precisely assessing the pathophysiology based on age-related functional changes, including the immune and structural system.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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Ferreira DS, Kaushik S, Smith CL, Dharmage SC, Benke GP, Thompson BR, Walters EH, Wolfe R, Abramson MJ. Associations of atopy and asthma during aging of an adult population over a 20-year follow-up. J Asthma 2017; 55:994-1001. [PMID: 28976229 DOI: 10.1080/02770903.2017.1386669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Atopy is associated with asthma, but cross-sectional studies suggest this association may be weaker in older adults. It remains unclear if atopy predicts asthma later in adult life. We aimed to investigate whether atopy in young adults predicted asthma 20 years later and to quantify the contemporaneous relationship of atopy and asthma as adults age. METHODS Participants of the European Community Respiratory Health Survey (ECRHS) in Melbourne aged 20-44 years were followed for 20 years and completed questionnaires, skin prick tests (SPT) and allergen specific immunoglobulin E measurement at a baseline and two subsequent surveys. Using logistic regression and generalized estimating equations, we tested if atopy at baseline predicted current asthma later in life and estimated the association between current atopy measured at each survey and current asthma, while adjusting for potential confounders. RESULTS The analysis included 220 participants: 50.9% male. Mean (SD) age at baseline was 35.7 (5.7) years. Asthma and atopy prevalence remained stable over 20 years. Baseline atopy (SPT) was associated with current asthma (OR 9.74, 95%CI 4.22, 22.5) over 20 years, and current atopy (SPT) with concurrent asthma (3.12; 1.70, 5.74). CONCLUSIONS Atopy remains strongly associated with current asthma in 40 to 64 year-old adults, both prospectively and contemporaneously, but the prospective association is stronger.
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Affiliation(s)
- Diogenes S Ferreira
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Sonia Kaushik
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Catherine L Smith
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Shyamali C Dharmage
- b Allergy & Lung Health Unit , Melbourne School of Global & Population Health , Melbourne , Australia
| | - Geza P Benke
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Bruce R Thompson
- c Allergy, Immunology & Respiratory Medicine, The Alfred , Melbourne , Australia
| | - E Haydn Walters
- d University of Tasmania , Tasmania 7005 , Australia.,e University of Notre Dame , Victoria 3030 , Australia
| | - Rory Wolfe
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
| | - Michael J Abramson
- a Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine , Monash University , Melbourne , Australia
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14
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Depression and Asthma Outcomes in Older Adults: Results from the National Health and Nutrition Examination Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017. [DOI: 10.1016/j.jaip.2017.03.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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de Roos EW, In 't Veen JCCM, Braunstahl GJ, Lahousse L, Brusselle GGO. Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects. Drugs Aging 2017; 33:619-28. [PMID: 27638817 DOI: 10.1007/s40266-016-0397-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients. For targeted therapy it is important to account for aging, as this affects the distribution of phenotypes (e.g. late-onset asthma, non-eosinophilic asthma) and may alter biomarkers and drug metabolism. Elderly asthmatics suffer from age-related comorbidities and subsequent polypharmacy. A systematic search into targeted asthma therapy yielded no randomized clinical trials dedicated to older asthmatics. Post hoc analyses of the anti-immunoglobulin E agent omalizumab indicate similar efficacy in both younger and older adults. Conference abstracts on anti-interleukin-5 and anti-interleukin-13 therapy suggest even more pronounced effects of targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but full reports are lacking. For non-eosinophilic asthma in the elderly, there is not yet high-level evidence for targeted therapy, but macrolides may offer a viable option. In conclusion, there is a gap in knowledge regarding the effect of older age on the safety and efficacy of targeted asthma therapy. Further investigations in the elderly are needed, with special emphasis on both late-onset asthma and therapeutics for non-eosinophilic asthma.
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Affiliation(s)
- E W de Roos
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J C C M In 't Veen
- Department of Respiratory Medicine, Franciscus Gasthuis, 3045 PM, Rotterdam, The Netherlands
| | - G-J Braunstahl
- Department of Respiratory Medicine, Franciscus Gasthuis, 3045 PM, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - L Lahousse
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - G G O Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Chiba S, Tsuchiya K, Ogata T, Imase R, Yagi T, Mishima Y, Jinta T, Saito K, Taki R, Isogai S, Jinn Y, Kawasaki T, Natsume I, Miyashita Y, Takagiwa J, Ishiwata N, Chiaki T, Kishi M, Tsukada Y, Yamasaki M, Inase N. Treatment of Asthma in the Elderly: Questionnaire Survey in Japan. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ijcm.2017.84023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Evaluation of long-term safety and efficacy of omalizumab in elderly patients with uncontrolled allergic asthma. Ann Allergy Asthma Immunol 2016; 117:546-549. [PMID: 27788886 DOI: 10.1016/j.anai.2016.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Severe asthma management in elderly patients may be difficult because of increased comorbid conditions, polypharmacy, physiologic changes that occur with aging, incorrect use of inhaler devices, and poor adherence. OBJECTIVE To evaluate the long-term safety and efficacy of the anti-IgE antibody omalizumab in elderly (aged ≥65 years) patients with uncontrolled allergic asthma. METHODS The efficiency and adverse effects of omalizumab treatment were evaluated based on data extracted from medical records. Patients were evaluated monthly for efficacy and adverse reactions. Treatment efficacy was evaluated by level of asthma symptom control, using the Global Initiative for Asthma guideline. RESULTS Nineteen consecutive elderly patients with asthma (female to male ratio, 14:5) formed our cohort. The mean (SD) age, disease duration, and total IgE level were 69.3 (5.8) years, 19.4 (8.6) years, and 299.1 (197.2) IU/mL, respectively. The mean (SD) duration of omalizumab treatment was 35.6 (17.8) months (range, 9-66 months). All the patients had at least 1 perennial inhalant allergen sensitivity and had uncontrolled allergic asthma. Elderly patients experienced no significantly important adverse reaction considered to be related to omalizumab treatment. Only 1 patient had a local adverse reaction and 1 had myalgia that was considered to be drug related. After omalizumab treatment, asthma symptoms were well controlled in 9 patients (47.4%) and partly controlled in 8 patients (42.1%). Two of the patients (10.5%) still had uncontrolled asthma. CONCLUSION Our study found that omalizumab is a well-tolerated and effective therapy for elderly patients with uncontrolled asthma.
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18
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Abstract
Asthma affects a significant proportion of elderly patients, but unfortunately, it is responsible for a high asthma-related morbidity and mortality in this population. This may be related not only to the development of a more severe asthma phenotype compared to younger patients, with more marked airway obstruction and a more neutrophilic type of airway inflammation, but also to the presence of many co-morbid conditions. Furthermore, in older patients, asthma is often under-diagnosed, undertreated and poorly managed. Unfortunately, elderly patients have usually been excluded of clinical trials on asthma and there is an urgent need to perform more research on the optimal management of asthma in this population.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, Chemin Sainte-Foy, Québec City, Québec G1V 4G5 Canada
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Kim MY, Song WJ, Cho SH. Pharmacotherapy in the management of asthma in the elderly: a review of clinical studies. Asia Pac Allergy 2016; 6:3-15. [PMID: 26844215 PMCID: PMC4731478 DOI: 10.5415/apallergy.2016.6.1.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/12/2016] [Indexed: 12/29/2022] Open
Abstract
Asthma in the elderly is a disease with emerging concern. Despite some recent advances in our understanding of epidemiology and pathophysiology, there is a considerable lack of clinical evidence specific to elderly patients. Currently available high quality clinical evidence has been mostly obtained from younger adults, but rarely from elderly patients. Under-representation of elderly patients in previous randomized trials may have been due to being, old age, or having comorbidities. Thus, a question may be raised whether current clinical evidence could be well generalized into elderly patients. Further clinical trials should address clinical issues raised in elderly population. In this review, we aimed to overview the efficacy and safety of pharmacological management, and also to summarize the literature relevant to elderly asthma.
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Affiliation(s)
- Mi-Yeong Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
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Battaglia S, Benfante A, Scichilone N. Asthma in the older adult: presentation, considerations and clinical management. Expert Rev Clin Immunol 2015; 11:1297-308. [PMID: 26358013 DOI: 10.1586/1744666x.2015.1087850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Asthma affects older adults to the same extent as children and adolescents. However, one is led to imagine that asthma prevalence decreases with aging and becomes a rare entity in the elderly. From a clinical perspective, this misconception has nontrivial consequences in that the recognition of the disease is delayed and the treatment postponed. The overall management of asthma in the elderly population is also complicated by specific features that the disease develops in the most advanced ages, and by the difficulties that the physician encounters when approaching the older asthmatic subjects. The current review article aims at describing the specific clinical presentations of asthma in the elderly and highlights the gaps and pitfalls in the diagnostic and therapeutic approaches. Relevant issues with regard to the clinical management of asthma in the elderly are also discussed.
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Affiliation(s)
- Salvatore Battaglia
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo Palermo, Italy
| | - Alida Benfante
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo Palermo, Italy
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21
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Song WJ, Cho SH. Challenges in the Management of Asthma in the Elderly. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:431-9. [PMID: 26122503 PMCID: PMC4509655 DOI: 10.4168/aair.2015.7.5.431] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/23/2015] [Indexed: 01/06/2023]
Abstract
Recent literature has emphasized the clinical and socio-epidemiological significance of asthma in the elderly. However, why the disease burden remains high in this group is unclear. Elderly subjects usually have multiple chronic illnesses, and the role played by comorbidities in the context of asthma has been underappreciated. This review aims to summarize the literature associations between comorbidities and asthma in elderly patients. In addition, we discuss patient management issues.
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Affiliation(s)
- Woo Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.
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22
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23
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Ponte EV, Stelmach R, Franco R, Souza-Machado C, Souza-Machado A, Cruz AA. Age is not associated with hospital admission or uncontrolled symptoms of asthma if proper treatment is offered. Int Arch Allergy Immunol 2014; 165:61-7. [PMID: 25342531 DOI: 10.1159/000367924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aging modifies immune response and respiratory physiology. Few studies evaluate the effect of age on asthma. The aim of our study was to evaluate whether age is associated with uncontrolled symptoms and hospital admissions due to asthma in a setting where patients were receiving proper treatment. METHODS We enrolled 401 patients with uncontrolled asthma who were inhaled corticosteroid-naive. The follow-up period was 1 year. They received medications for asthma, performed spirometry, a symptoms questionnaire, and all emergency room visits and hospital admissions due to asthma were reported. The primary end point was hospital admission during the follow-up period. RESULTS Baseline data demonstrated that subjects >55 years of age had a later onset of asthma and a longer duration of symptoms. Adjusted logistic regression models demonstrated that older age at enrollment did not predict asthma control in the follow-up: hospital admission due to asthma [odds ratio (OR) 1.7 and 95% confidence interval (CI) 0.6-4.7], symptoms score (OR 0.6 and 95% CI 0.3-1.1) and emergency room visits due to asthma (OR 0.9 and 95% CI 0.6-1.3). Older age was associated with worse lung function (OR 1.8 and 95% CI 1.1-3.3). CONCLUSION This study allows us to conclude that older age is associated with a later onset of asthma and a longer duration of symptoms. Age does not predict hospital admissions or poor control of asthma symptoms if proper treatment is offered. It does, however, predict worse lung function.
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Affiliation(s)
- Eduardo Vieira Ponte
- Faculdade de Medicina de Jundiaí, Universidade Federal da Bahia, Jundiaí, Brazil
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Kämpe M, Lisspers K, Ställberg B, Sundh J, Montgomery S, Janson C. Determinants of uncontrolled asthma in a Swedish asthma population: cross-sectional observational study. Eur Clin Respir J 2014; 1:24109. [PMID: 26557235 PMCID: PMC4629716 DOI: 10.3402/ecrj.v1.24109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/19/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Asthma control is achieved in a low proportion of patients. The primary aim was to evaluate risk factors for uncontrolled asthma. The secondary aim was to assess quality of life associated with asthma control. METHODS In a cross-sectional study, asthma patients aged 18-75 were randomly selected from primary and secondary health care centers. Postal questionnaires were sent to 1,675 patients and the response rate was 71%. A total of 846 patients from primary and 341 patients from secondary care were evaluated. Data were collected using a questionnaire and review of medical records. The questionnaire included questions about asthma control and a quality-of-life questionnaire, the mini-AQLQ, with four domains (symptoms, activity limitation, emotional function, and environmental stimuli). The mean score for each domain and the overall score were calculated. Asthma control was divided into three levels according to the GINA guidelines and partly and uncontrolled asthma were combined into one group - poorly controlled asthma. RESULTS Asthma control was achieved in 36% of the sample: 38% in primary and 29% in secondary care. In primary and secondary care, 35 and 45% had uncontrolled asthma, respectively. Risk factors for poorly controlled asthma were female sex [OR 1.31 (1.003-1.70)], older age [OR 2.18 (1.28-3.73)], lower educational level [OR 1.63 (1.14-2.33)], and current smoking [OR 1.68 (1.16-2.43)]. Older age and lower educational level remained statistically significantly associated with poorly controlled asthma when the analyses were limited to never-smokers. Depression was an independent risk factor for poorly controlled asthma in men [OR 3.44 (1.12-10.54)]. The mini-AQLQ scores and the mean overall score were significantly lower in uncontrolled asthma. CONCLUSION Risk factors for poorly controlled asthma were female sex, older age, low educational level, and smoking. Uncontrolled asthma was significantly associated with lower quality of life.
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Affiliation(s)
- Mary Kämpe
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, Örebro University Hospital and Örebro University, Örebro, Sweden ; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden ; Department of Epidemiology and Public Health, University College London, UK
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University Uppsala, Sweden
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Robitaille C, Boulet LP. [Asthma in the elderly]. Rev Mal Respir 2014; 31:478-87. [PMID: 25012034 DOI: 10.1016/j.rmr.2014.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/16/2014] [Indexed: 01/09/2023]
Abstract
Asthma is a common condition in the elderly although often confounded with chronic obstructive pulmonary disease (COPD) in this population. Asthma in the elderly seems to represent a specific phenotype characterized by more severe, but often less perceived, airway obstruction, a neutrophilic or mixed-type of airway inflammation and frequent comorbidities. Patients aged 65 years and over have an increased asthma-related morbidity and mortality compared to younger patients, probably due to difficulties in regard to diagnosis, assessment of the disease severity and treatment. Research is urgently needed to determine the optimal treatment of the aged patient. In this document we will review the state of knowledge on this topic and discuss the challenges of multidisciplinary asthma management in the elderly.
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Affiliation(s)
- C Robitaille
- Institut universitaire de cardiologie et de pneumologie de Québec, université Laval, 2725, chemin Sainte-Foy, G1V 4G5 Québec, QC, Canada
| | - L-P Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, université Laval, 2725, chemin Sainte-Foy, G1V 4G5 Québec, QC, Canada.
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Bożek A, Filipowski M, Fischer A, Jarzab J. Characteristics of atopic bronchial asthma in seniors over 80 years of age. BIOMED RESEARCH INTERNATIONAL 2013; 2013:689782. [PMID: 23984398 PMCID: PMC3747429 DOI: 10.1155/2013/689782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Asthma in the elderly is an important public health problem. The aim of this study was to assess the prevalence and characteristics of asthma in seniors. MATERIALS AND METHODS The study involved 105 people of at least 80 years of age (mean age of 84.1 ± 3.9 years) selected from a group of 1860 individuals. Spirometry, the methacholine test, allergy diagnosis, a measurement of exhaled nitric oxide, and administration of the asthma quality of life questionnaire (AQLQ) were performed. RESULTS The average morbidity of asthma in the study population of elderly people (at least 80 years of age) was 5.6% (105 people) of the confidence interval (95% CI: 5.1-6.0). In the study group, 34% of the elderly asthmatics had uncontrolled asthma, 47% had partly controlled asthma, and only 24% had fully controlled asthma. Allergy to house dust mites was predominant. The average total score on the AQLQ was 4.12 ± 0.72 (arithmetic mean ± standard deviation) for the seniors, which was significantly lower than the score for the young. CONCLUSION The pathogenesis, natural history, and value of the basic diagnostic methods of asthma in the elderly are similar to those observed in younger age groups.
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Affiliation(s)
- Andrzej Bożek
- Clinical Department of Internal Medicine, Dermatology and Allergology, Medical University of Silesia, M. Sklodowskiej-Curie 10, 41-800 Zabrze, Poland
| | - Marek Filipowski
- Clinical Department of Chest Surgery, Medical University of Silesia, 41-880 Zabrze, Poland
| | | | - Jerzy Jarzab
- Clinical Department of Internal Medicine, Dermatology and Allergology, Medical University of Silesia, M. Sklodowskiej-Curie 10, 41-800 Zabrze, Poland
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Abstract
A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics.
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Affiliation(s)
- Andrea S Melani
- Fisiopatologia e Riabilitazione Respiratoria, Dipartimento Vasi, Cuore e Torace, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.
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Akushevich I, Kravchenko J, Ukraintseva S, Arbeev K, Yashin AI. Recovery and survival from aging-associated diseases. Exp Gerontol 2013; 48:824-30. [PMID: 23707929 DOI: 10.1016/j.exger.2013.05.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 04/05/2013] [Accepted: 05/16/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Considering disease incidence to be a main contributor to healthy lifespan of the US elderly population may lead to erroneous conclusions when recovery/long-term remission factors are underestimated. Using two Medicare-based population datasets, we investigated the properties of recovery from eleven age-related diseases. METHODS Cohorts of patients who stopped visiting doctors during a five-year follow-up since disease onset were analyzed non-parametrically and using the Cox proportional hazard model resulted in estimated recovery and survival rates and evaluated the health state of recovered individuals by comparing their survival with non-recovered patients and the general population. RESULTS Recovered individuals had lower death rates than non-recovered patients, therefore, patients who stopped visiting doctors are a healthier subcohort. However, they had higher death rates than in general population for all considered diseases, therefore the complete recovery does not occur. CONCLUSION Properties of recovery/long-term remission among the US population of older adults with chronic diseases were uncovered and evaluated. The results allow for a better quantifiable contribution of age-related diseases to healthy life expectancy and improving forecasts of health and mortality.
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Affiliation(s)
- Igor Akushevich
- Center for Population Health and Aging, Duke University, Durham, NC 27708, United States.
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Tsai CL, Delclos GL, Huang JS, Hanania NA, Camargo CA. Age-related differences in asthma outcomes in the United States, 1988-2006. Ann Allergy Asthma Immunol 2013; 110:240-6, 246.e1. [PMID: 23535086 DOI: 10.1016/j.anai.2013.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relatively little is known about the effect of age on asthma outcomes in adults, particularly at a national level. OBJECTIVE To investigate age-related differences in asthma outcomes in a nationally representative, longitudinal study. METHODS We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) with linked mortality files through 2006. Adults with physician-diagnosed asthma were identified and were divided into 2 age groups: younger adults (17-54 years of age) and older adults (55 years or older). The outcome measures were both cross-sectional (health care use, comorbidity, and lung function) and longitudinal (all-cause mortality). RESULTS There were an estimated 9,566,000 adults with current asthma. Of these, 73% were younger adults and 27% older adults. Compared with younger adults, older adults had more hospitalizations in the past year, more comorbidities, and poorer lung function (eg, lower forced expiratory volume in 1 second) (P < .05 for all). During a median follow-up of 15 years, significant baseline predictors of higher all-cause mortality included older age (≥55 vs <55 years old: adjusted hazard ratio [HR], 6.77; 95% confidence interval [CI], 3.15-14.54), poor health status (fair and poor vs excellent health status: adjusted HR, 10.07; 95% CI, 3.75-27.01), and vitamin D deficiency (vitamin D level <30 vs ≥50 nmol/L: adjusted HR, 2.19; 95% CI, 1.05-4.58), whereas Mexican American ethnicity (adjusted HR, 0.31; 95% CI, 0.14-0.65) was associated with lower mortality. Controlling for age, asthma was not associated with increased all-cause mortality (adjusted HR, 1.28; 95% CI, 0.99-1.65). CONCLUSION Older adults with asthma have a substantial burden of morbidity and increased mortality. The ethnic differences in asthma mortality and the vitamin D-mortality link merit further investigation.
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Affiliation(s)
- Chu-Lin Tsai
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas 77030, USA.
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Chipps BE, Zeiger RS, Dorenbaum A, Borish L, Wenzel SE, Miller DP, Hayden ML, Bleecker ER, Simons FER, Szefler SJ, Weiss ST, Haselkorn T. Assessment of asthma control and asthma exacerbations in the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) observational cohort. CURRENT RESPIRATORY CARE REPORTS 2012; 1:259-269. [PMID: 23136642 PMCID: PMC3485530 DOI: 10.1007/s13665-012-0025-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with severe or difficult-to-treat asthma account for substantial asthma morbidity, mortality, and healthcare burden despite comprising only a small proportion of the total asthma population. TENOR, a multicenter, observational, prospective cohort study was initiated in 2001. It enrolled 4,756 adults, adolescents and children with severe or difficult-to-treat asthma who were followed semi-annually and annually for three years, enabling insight to be gained into this understudied population. A broad range of demographic, clinical, and patient self-reported assessments were completed during the follow-up period. Here, we present key findings from the TENOR registry in relation to asthma control and exacerbations, including the identification of specific subgroups found to be at particularly high-risk. Identification of the factors and subgroups associated with poor asthma control and increased risk of exacerbations can help physicians design individual asthma management, and improve asthma-related health outcomes for these patients.
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Affiliation(s)
- Bradley E. Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, 5609 J Street, Suite C, Sacramento, CA 95819 USA
| | - Robert S. Zeiger
- Department of Allergy, Kaiser Permanente SD, 7060 Clairemont Mesa Blvd, San Diego, CA 92111 USA
| | | | - Larry Borish
- Asthma and Allergic Disease Center, University of Virginia, Charlottesville, VA 22908 USA
| | - Sally E. Wenzel
- Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Asthma Institute, NW 931 Montefiore, 3459 Fifth Ave, Pittsburgh, PA 15213 USA
| | - Dave P. Miller
- ICON Clinical Research, 188 The Embarcadero # 200, San Francisco, CA 94105 USA
| | - Mary Lou Hayden
- University of Virginia Employee Health, P.O. Box 800398, Charlottesville, VA 22908 USA
| | - Eugene R. Bleecker
- Center for Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 USA
| | - F. Estelle R. Simons
- Department of Pediatrics and Child Health, Department of Immunology, University of Manitoba, 820 Sherbrook St, Winnipeg, Manitoba, Canada R3A 1R9
| | - Stanley J. Szefler
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, 1400 Jackson Street, Denver, CO 80206 USA
| | - Scott T. Weiss
- Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115 USA
| | - Tmirah Haselkorn
- Genentech, Inc, MS-58B, 1 DNA Way, South San Francisco, CA 94080 USA
| | - TENOR Study Group
- Capital Allergy and Respiratory Disease Center, Sacramento, 5609 J Street, Suite C, Sacramento, CA 95819 USA
- Department of Allergy, Kaiser Permanente SD, 7060 Clairemont Mesa Blvd, San Diego, CA 92111 USA
- Genentech, Inc, MS-58B, 1 DNA Way, South San Francisco, CA 94080 USA
- Asthma and Allergic Disease Center, University of Virginia, Charlottesville, VA 22908 USA
- Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Asthma Institute, NW 931 Montefiore, 3459 Fifth Ave, Pittsburgh, PA 15213 USA
- ICON Clinical Research, 188 The Embarcadero # 200, San Francisco, CA 94105 USA
- University of Virginia Employee Health, P.O. Box 800398, Charlottesville, VA 22908 USA
- Center for Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 USA
- Department of Pediatrics and Child Health, Department of Immunology, University of Manitoba, 820 Sherbrook St, Winnipeg, Manitoba, Canada R3A 1R9
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, 1400 Jackson Street, Denver, CO 80206 USA
- Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115 USA
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Abstract
With the improvement of medical care and hygienic conditions, there has been a tremendous increment in human lifespan. However, many of the elderly (>65 years) display chronic illnesses, and a majority requires frequent and longer hospitalization. The robustness of the immune system to eliminate or control infections is often eroded with advancing age. Nevertheless, some elderly individuals do cope better than others. The origin of these inter-individual differences may come from genetic, lifestyle conditions (nutrition, socio-economic parameters), as well as the type, number and recurrence of pathogens encountered during life. The theory we are supporting is that chronic infections, through life, will induce profound changes in the immune system probably due to unbalanced inflammatory profiles. Persistent viruses such a cytomegalovirus are not eliminated and are a driven force to immune exhaustion. Because of their age, elderly individuals may have seen more of these chronic stimulators and have experienced more reactivation episodes ultimately leading to shrinkage of their repertoire and overall immune robustness. This review integrates updates on immunity with advancing age and its impact on associated clinical conditions.
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Matsunaga K, Akamatsu K, Hirano T, Ichinose M. Response to treatment in individuals with late-onset asthma. J Am Geriatr Soc 2012; 60:1587-8. [PMID: 22889028 DOI: 10.1111/j.1532-5415.2012.04083.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davis E, Coover K, Morrow L, Malesker M. Differentiating the treatment of asthma and chronic obstructive pulmonary disease in the elderly patient. ACTA ACUST UNITED AC 2012; 27:650-9. [PMID: 22982749 DOI: 10.4140/tcp.n.2012.650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The focus of this case is a 70-year-old female who was admitted to an assisted living community following a hospitalization for a severe asthma exacerbation. The diagnosis of asthma in the geriatric patient is often under-recognized, misdiagnosed, and improperly managed. Several factors may explain the misclassification and the undertreatment of asthma in the older patient. This case discusses the pharmacotherapeutic management of asthma in the geriatric patient and differentiates the clinical features of asthma from that of chronic obstructive lung disease. The comprehensive management of asthma should include an interprofessional approach because the consultant pharmacist is an essential member of the health care team.
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Affiliation(s)
- Estella Davis
- Creighton University School of Pharmacy and Health Professions, Omaha, NE 68178, USA.
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Crane MA, Douglass JA, Goeman DP, Cousens NE, Jenkins CR. Development and validation of the Patient Asthma Concerns Tool (PACT) to identify the needs of older people with asthma. Respir Med 2012; 106:1501-8. [PMID: 22921865 DOI: 10.1016/j.rmed.2012.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tools which assist practitioners to identify patient concerns and increase understanding of their needs can improve both the delivery of care and adherence to treatment. The aim of this study was to test the validity and reliability of a 14-item tool, to identify the unmet needs and concerns of older people with asthma. METHODS The Patient Asthma Concerns Tool (PACT) was developed from a pool of 55 items derived from a comprehensive literature review. After pilot and field testing, the initial 55 item questionnaire was administered to a community sample (n = 193), psychometrically tested, and refined to a 14 item PACT tool which was evaluated by a group of clinicians. RESULTS The PACT was shown to have good content and construct validity and was well received by clinicians. The PACT also correlated well with the Juniper ACQ and Brooks' adherence score on related variables and showed good reliability with good-excellent Kappa and ICC scores. Internal consistency of factors was high, and the overall Cronbach's α was 0.70. CONCLUSION The PACT questionnaire was shown to be a valid and reliable tool clinically and psychometrically. We intend to test it in primary care settings and anticipate that its use will assist health professionals to identify the needs and concerns of older patients with asthma and direct tailored asthma management accordingly.
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35
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Chipps BE, Zeiger RS, Borish L, Wenzel SE, Yegin A, Hayden ML, Miller DP, Bleecker ER, Simons FER, Szefler SJ, Weiss ST, Haselkorn T. Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol 2012; 130:332-42.e10. [PMID: 22694932 PMCID: PMC3622643 DOI: 10.1016/j.jaci.2012.04.014] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 02/14/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
Abstract
Patients with severe or difficult-to-treat asthma are an understudied population but account for considerable asthma morbidity, mortality, and costs. The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study was a large, 3-year, multicenter, observational cohort study of 4756 patients (n=3489 adults ≥ 18 years of age, n=497 adolescents 13-17 years of age, and n=770 children 6-12 years of age) with severe or difficult-to-treat asthma. TENOR's primary objective was to characterize the natural history of disease in this cohort. Data assessed semiannually and annually included demographics, medical history, comorbidities, asthma control, asthma-related health care use, medication use, lung function, IgE levels, self-reported asthma triggers, and asthma-related quality of life. We highlight the key findings and clinical implications from more than 25 peer-reviewed TENOR publications. Regardless of age, patients with severe or difficult-to-treat asthma demonstrated high rates of health care use and substantial asthma burden despite receiving multiple long-term controller medications. Recent exacerbation history was the strongest predictor of future asthma exacerbations. Uncontrolled asthma, as defined by the 2007 National Heart, Lung, and Blood Institute guidelines' impairment domain, was highly prevalent and predictive of future asthma exacerbations; this assessment can be used to identify high-risk patients. IgE and allergen sensitization played a role in the majority of severe or difficult-to-treat asthmatic patients.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA 95819, USA.
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Vaz Fragoso CA, Concato J, McAvay G, Van Ness PH, Gill TM. Respiratory impairment and COPD hospitalisation in older persons: a competing risk analysis. Eur Respir J 2012; 40:37-44. [PMID: 22267770 PMCID: PMC3773173 DOI: 10.1183/09031936.00128711] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to evaluate, among older persons, the association between respiratory impairment and hospitalisation for chronic obstructive pulmonary disease (COPD), based on spirometric Z-scores, i.e. the LMS (lambda, mu, sigma) method, and a competing risk approach. Using data on 3,563 white participants aged 65-80 yrs (from the Cardiovascular Health Study) we evaluated the association of LMS-defined respiratory impairment with the incident of COPD hospitalisation and the competing outcome of death without COPD hospitalisation, over a 5-yr period. Respiratory impairment included airflow limitation (mild, moderate or severe) and restrictive pattern. Over a 5-yr period, 276 (7.7%) participants had a COPD hospitalisation incident, whereas 296 (8.3%) died without COPD hospitalisation. The risk of COPD hospitalisation was elevated more than two-fold in LMS-defined mild and moderate airflow limitation and restrictive pattern (adjusted HR (95% CI): 2.25 (1.25-4.05), 2.54 (1.53- 4.22) and 2.65 (1.82-3.86), respectively), and more than eight-fold in LMS-defined severe airflow limitation (adjusted HR (95% CI) 8.33 (6.24-11.12)). Conversely, only LMS-defined restrictive-pattern was associated with the competing outcome of death without COPD hospitalisation (adjusted HR (95% CI) 1.68 (1.22-2.32)). In older white persons, LMS-defined respiratory impairment is strongly associated with an increased risk of COPD hospitalisation. These results support the LMS method as a basis for defining respiratory impairment in older persons.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave, Mailcode 151B, West Haven, CT, USA.
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37
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Tsai CL, Lee WY, Hanania NA, Camargo CA. Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008. J Allergy Clin Immunol 2012; 129:1252-1258.e1. [DOI: 10.1016/j.jaci.2012.01.061] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/23/2012] [Accepted: 01/27/2012] [Indexed: 11/16/2022]
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Smith AM, Villareal M, Bernstein DI, Swikert DJ. Asthma in the elderly: risk factors and impact on physical function. Ann Allergy Asthma Immunol 2012; 108:305-10. [PMID: 22541399 DOI: 10.1016/j.anai.2012.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/23/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The incidence rate of asthma has increased in all age groups in the past 40 years. Asthma in older adults is underdiagnosed and undertreated, resulting in suboptimal asthma control. OBJECTIVE The objectives of the study are to evaluate differences in host characteristics between older patients with asthma and persons who do not have asthma and how these differences impact overall quality of life. METHODS Patients older than age 60 years were recruited from the general population for this case/control and nested cohort study. A complete medical history, physical examination, skin prick testing (SPT), spirometry, and exhaled nitric oxide (ENO) measurements were performed. Quality of life was assessed through the standardized SF-36v2 questionnaire. Quality of life scores, spirometry, ENO, and aeroallergen sensitization differences were compared between older patients with asthma and control patients. RESULTS The mean age of the 77 patients evaluated was 68.7 ± 7.2 years, with 59 (77%) being female. A higher rate of SPT positivity was found in patients with asthma (88.9%) compared with controls (51.2%) (P = .007). The mean percent predicted forced expiratory volume in 1 second (FEV1) at baseline was lower in the asthma group (73.7 ± 21.9%) compared with controls (89.6 ± 19.1%) (P = .007). For quality of life assessed by the SF-36v2 questionnaire, the asthma group had worse general health, increased bodily pain, and worse overall physical health compared with controls (P = .02; .021; .01). CONCLUSION Older adults with asthma have a higher rate of allergic sensitization, decreased lung function, and significantly worse quality of life compared with controls.
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Affiliation(s)
- Andrew M Smith
- University of Cincinnati Medical Center,Division of Immunology, 231 Albert Sabin Way, Cincinnati, OH 45267-0563, USA.
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39
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Newman AB, Cauley JA. Asthma and COPD. THE EPIDEMIOLOGY OF AGING 2012. [PMCID: PMC7121932 DOI: 10.1007/978-94-007-5061-6_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anne B. Newman
- , Graduate School of Public Health, University of Pittsburgh, A527 Crabtree Hall, DeSoto Street 130, Pittsburgh, 15261 Pennsylvania USA
| | - Jane A. Cauley
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, DeSoto Street, A510 Crabtree 130, Pittsburgh, 15261 Pennsylvania USA
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Viswanathan RK, Mathur SK. Role of allergen sensitization in older adults. Curr Allergy Asthma Rep 2011; 11:427-33. [PMID: 21667198 DOI: 10.1007/s11882-011-0204-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is a common perception among physicians and patients that allergic diseases are not relevant in older adults. There is also recognition that innate and adaptive immune functions decline with aging. It is the function of a variety of immune cells in the form of allergic inflammation that is a hallmark of allergic diseases. In fact, there is a fairly consistent observation that measures of allergic sensitization, such as skin prick testing, specific IgE, or total IgE, decline with age. Nonetheless, the association between allergic sensitization and allergic diseases, particularly asthma and allergic rhinitis, remains robust in the older adult population. Consequently, an appropriate evaluation of allergic sensitivities is warranted and indicated in older asthma and rhinitis patients to provide optimal care for the individual and minimize any resultant morbidity and mortality.
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Affiliation(s)
- Ravi K Viswanathan
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, K4/952 CSC, 600 Highland Avenue, Madison, WI 53792, USA
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Hanania NA, King MJ, Braman SS, Saltoun C, Wise RA, Enright P, Falsey AR, Mathur SK, Ramsdell JW, Rogers L, Stempel DA, Lima JJ, Fish JE, Wilson SR, Boyd C, Patel KV, Irvin CG, Yawn BP, Halm EA, Wasserman SI, Sands MF, Ershler WB, Ledford DK. Asthma in the elderly: Current understanding and future research needs--a report of a National Institute on Aging (NIA) workshop. J Allergy Clin Immunol 2011; 128:S4-24. [PMID: 21872730 PMCID: PMC3164961 DOI: 10.1016/j.jaci.2011.06.048] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/27/2022]
Abstract
Asthma in the elderly is underdiagnosed and undertreated, and there is a paucity of knowledge on the subject. The National Institute on Aging convened this workshop to identify what is known and what gaps in knowledge remain and suggest research directions needed to improve the understanding and care of asthma in the elderly. Asthma presenting at an advanced age often has similar clinical and physiologic consequences as seen with younger patients, but comorbid illnesses and the psychosocial effects of aging might affect the diagnosis, clinical presentation, and care of asthma in this population. At least 2 phenotypes exist among elderly patients with asthma; those with longstanding asthma have more severe airflow limitation and less complete reversibility than those with late-onset asthma. Many challenges exist in the recognition and treatment of asthma in the elderly. Furthermore, the pathophysiologic mechanisms of asthma in the elderly are likely to be different from those seen in young asthmatic patients, and these differences might influence the clinical course and outcomes of asthma in this population.
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Affiliation(s)
- Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Asthma Clinical Research Center, Baylor College of Medicine, Houston, Tex., USA
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Cardona V, Guilarte M, Luengo O, Labrador-Horrillo M, Sala-Cunill A, Garriga T. Allergic diseases in the elderly. Clin Transl Allergy 2011; 1:11. [PMID: 22409889 PMCID: PMC3339328 DOI: 10.1186/2045-7022-1-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/17/2011] [Indexed: 01/24/2023] Open
Abstract
Demographic distribution of the population is progressively changing with the proportion of elderly persons increasing in most societies. This entails that there is a need to evaluate the impact of common diseases, such as asthma and other allergic conditions, in this age segment. Frailty, comorbidities and polymedication are some of the factors that condition management in geriatric patients. The objective of this review is to highlight the characteristics of allergic diseases in older age groups, from the influence of immunosenescence, to particular clinical implications and management issues, such as drug interactions or age-related side effects.
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Affiliation(s)
- Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Guilarte
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Olga Luengo
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Moises Labrador-Horrillo
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Anna Sala-Cunill
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Teresa Garriga
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Shendell DG, Foster C, Sexton J, Roden J, Yamamoto N, Kelly SW, Chandler WL, Venables M, Williams S, Burr S, Wagenleitner V, Anderson N. Knowledge and Awareness of Symptoms, Triggers, and Treatment Among Older Adults With Asthma and/or Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/2150129710393338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma can be controlled through proper clinical and environmental management and education; however, public health and allied health professionals, such as respiratory therapists, have not typically been trained in environmental engineering and building safety concepts critical to addressing indoor environmental asthma and allergy triggers. The population is growing and aging: low- to middle-income seniors are working and living longer, and incidence and prevalence of chronic respiratory diseases continue increasing. The authors conducted a community-based participatory research pilot project with a cross-sectional repeated measures design in Visalia, California. This paper presents the study process, the impact of asthma and allergy on quality of life, and the environment- and health-related data collected via 3 baseline knowledge and awareness questionnaires and the technician walk-through survey on the home environment and asthma triggers. Participants were confirmed at baseline as having 1 or more physician-diagnosed respiratory diseases: asthma, bronchitis, chronic obstructive pulmonary disease. Questionnaires were administered to recruited consenting participants meeting selection criteria (n, 34; convenience sample) at community locations. At baseline, 12 agreed to comprehensive home visits: 9 of whom completed first visits, of which 6 completed second visits. One baseline questionnaire was repeated at first seasonal home visits; 2 of 6 participants completed it again at second seasonal home visits. Participants completing home visits (eg, receiving education from local asthma coalition members) increased clinical asthma management knowledge and awareness. Results suggested areas for improvement in future asthma education initiatives targeting older adults living independently, regarding indoor environmental triggers and underlying safety and health conditions.
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Affiliation(s)
- Derek G. Shendell
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Christine Foster
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - June Sexton
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Jeninne Roden
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Naomichi Yamamoto
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Sarah W. Kelly
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - with Leslie Chandler
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Michelle Venables
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Samantha Williams
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Stacey Burr
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Veronica Wagenleitner
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
| | - Nicole Anderson
- University of Medicine and Dentistry of New Jersey School of Public Health School of Public Health, Department of Environmental and Occupational Health and the Center for School and Community-Based Research and Education Piscataway, New Jersey (DGS, SWK)
- Respiratory Therapy Program, San Joaquin Valley College, Tulare County Asthma Coalition, Visalia, California (CF; students)
- Tulare County Asthma Coalition (JS, JR)
- Yale University Department of Chemical Engineering, New Haven, Connecticut (NY)
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Abstract
Allergies and asthma are diseases that affect individuals of all ages, and their prevalence is comparable in all age groups. As age demographics in the United States and other countries shift to greater proportions and numbers of patients in the "elderly" categories, it is becoming increasingly important for clinicians to become aware of the impact of aging on a variety of diseases. Allergy and asthma are recognized as inflammatory disorders, and there are data demonstrating that age-related changes in immune function can have a significant impact on these disorders.
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Braman SS. Growing old with asthma: what are the changes and challenges? Expert Rev Respir Med 2010; 4:239-48. [PMID: 20406090 DOI: 10.1586/ers.10.12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is a disease that affects approximately 7% of adults residing in the USA; the prevalence is even greater in children and approaches 10%. The CDC has reported that the overall prevalence of lifetime asthma is 10.5%. New-onset asthma is most often seen in children and is associated with atopy; however, the majority of patients will experience a remission during adolescence. Many former asthmatics will have a reoccurrence of their disease in adulthood and asthma may persist thereafter for a lifetime. New-onset asthma may also begin later in life and remission is uncommon. The burden of asthma is therefore high in the geriatric population and healthcare utilization and mortality from asthma is excessive in this age group. There are many differences with asthma occurring in older adults when compared with younger asthmatics. This includes the frequency of medical comorbidities, the presence in many patients of fixed airflow obstruction that resembles chronic obstructive pulmonary disease, and the lack of perception of dyspnea that may delay effective medical care. Despite these and other differences, the pathophysiology and clinical presentation of asthma in the elderly is similar to that in younger asthmatics and attention to the unique features of aging can lead to improved outcomes in this age group.
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Affiliation(s)
- Sidney S Braman
- Division of Pulmonary and Critical Care Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, APC 7, 594 Eddy Street, Providence, RI 02903, USA.
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46
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Antonelli-Incalzi R, Corsonello A, Pedone C, Battaglia S, Bellia V. Asthma in the elderly. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ahe.10.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Asthma is frequent among older people. Nevertheless, under-recognition, misdiagnosis and under-treatment are still relevant issues. We aim to provide an overview of epidemiology of asthma in the elderly, and a thorough description of its pathology and clinical presentation, with special emphasis on the distinction of late versus early-onset asthma. We also discuss selected treatment topics of special interest for older patients, such as compliance with therapy and ability with the inhalers, which are basic to the success of the prescribed therapy. Finally, we suggest that multidimensional geriatric assessment of older asthmatics could help in tailoring the therapy to the individual needs and capacity.
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Affiliation(s)
- Raffaele Antonelli-Incalzi
- Cattedra di Geriatria, Università Campus BioMedico, Rome, Italy
- Fondazione San Raffaele, Cittadella della Carità, Taranto, Italy
| | - Andrea Corsonello
- Istituto Nazionale di Ricovero e Cura per Anziani (INRCA), C. da Muoio Piccolo, I-87100 Cosenza, Italy
| | - Claudio Pedone
- Cattedra di Geriatria, Università Campus BioMedico, Rome, Italy
- Fondazione Alberto Sordi, Rome, Italy
| | - Salvatore Battaglia
- Dipartimento di Medicina, Pneumologia, Università di Palermo, Palermo, Italy
| | - Vincenzo Bellia
- Dipartimento di Medicina, Pneumologia, Università di Palermo, Palermo, Italy
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47
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Abstract
PURPOSE OF REVIEW Asthma is a common disease in the older population that is frequently undiagnosed and undertreated. We will review the current knowledge of asthma in the elderly (AIE) and shed light on the diagnostic and management challenges outlining needs for future research. RECENT FINDINGS There has been very little original research in the field of AIE published in the last few years, and current literature focuses primarily on a series of review articles. AIE often presents with multiple comorbidities, which complicates its course and management. There is renewed interest in nonallergic (intrinsic) asthma. T helper cell 1 inflammation triggered by respiratory infection, superantigens, proteases and interleukin 17 are possible mechanisms. An association between systemic inflammation in frailty and asthma may also be important. SUMMARY The diagnosis and treatment of AIE requires that the individual patient and his or her specific triggers and the likely pathophysiology be understood. Understanding the mechanisms of inflammation in this population is key to improved therapeutic interventions.
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48
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Pascual RM, Peters SP. The irreversible component of persistent asthma. J Allergy Clin Immunol 2009; 124:883-90; quiz 891-2. [PMID: 19895980 DOI: 10.1016/j.jaci.2009.09.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 11/19/2022]
Abstract
Irreversible airflow obstruction or limitation occurs in some patients with asthma, can develop early in life, and becomes more common as asthma becomes more severe. Efforts to understand irreversible airflow obstruction or limitation have been hampered by the lack of a standardized definition of the phenotype and by the lack of appropriate research models. Unfortunately, it appears that currently available asthma treatments do not prevent this important asthma complication. Herein, the evidence of an irreversible component of asthma, its underlying pathology, and the limitations of current asthma treatments are reviewed.
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Affiliation(s)
- Rodolfo M Pascual
- Department of Internal Medicine, Section on Pulmonary, Wake Forest University School of Medicine, Center for Human Genomics, Winston-Salem, NC 27157, USA.
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49
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Ito K, Mercado N. Therapeutic targets for new therapy for corticosteroid refractory asthma. Expert Opin Ther Targets 2009; 13:1053-67. [PMID: 19659447 DOI: 10.1517/14728220903078431] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Corticosteroids are the most potent anti-inflammatory agents for the treatment of mild to moderate asthma. However, a small percentage of the asthma population (< 10%) do not respond well, or at all, to corticosteroid therapy, and this severe corticosteroid-refractory asthma contributes to more than 50% of health care expenditure for all asthma because these is no appropriate pharmacological therapy. METHODS If the molecular mechanism of corticosteroid insensitivity is uncovered, it may in turn provide insights into the key mechanism of corticosteroid action and rational implementation of treatment regimens that restore corticosteroid sensitivity or replace corticosteroid therapy. This review focuses on why severe asthma patients are corticosteroid-insensitive, and discusses present and future therapeutic and preventative strategies for corticosteroid-refractory asthma. CONCLUSIONS Corticosteroid-refractory asthma is a heterogeneous disease and can be controlled by add-on treatment of corticosteroid-sparing agents or effective new drugs based on individual abnormalities. The elucidation of the cause of the relative lack of corticosteroid response in this subgroup of asthmatic individuals may have important implications for other diseases.
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Affiliation(s)
- Kazuhiro Ito
- National Heart and Lung Institute, Imperial College School of Medicine, Airways Disease Section, London SW3 6LY, UK.
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50
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Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL, Fiss E, Olivenstein R, Thomson NC, Niven RM, Pavord ID, Simoff M, Duhamel DR, McEvoy C, Barbers R, Ten Hacken NHT, Wechsler ME, Holmes M, Phillips MJ, Erzurum S, Lunn W, Israel E, Jarjour N, Kraft M, Shargill NS, Quiring J, Berry SM, Cox G. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med 2009; 181:116-24. [PMID: 19815809 DOI: 10.1164/rccm.200903-0354oc] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Bronchial thermoplasty (BT) is a bronchoscopic procedure in which controlled thermal energy is applied to the airway wall to decrease smooth muscle. OBJECTIVES To evaluate the effectiveness and safety of BT versus a sham procedure in subjects with severe asthma who remain symptomatic despite treatment with high-dose inhaled corticosteroids and long-acting beta(2)-agonists. METHODS A total of 288 adult subjects (Intent-to-Treat [ITT]) randomized to BT or sham control underwent three bronchoscopy procedures. Primary outcome was the difference in Asthma Quality of Life Questionnaire (AQLQ) scores from baseline to average of 6, 9, and 12 months (integrated AQLQ). Adverse events and health care use were collected to assess safety. Statistical design and analysis of the primary endpoint was Bayesian. Target posterior probability of superiority (PPS) of BT over sham was 95%, except for the primary endpoint (96.4%). MEASUREMENTS AND MAIN RESULTS The improvement from baseline in the integrated AQLQ score was superior in the BT group compared with sham (BT, 1.35 +/- 1.10; sham, 1.16 +/- 1.23 [PPS, 96.0% ITT and 97.9% per protocol]). Seventy-nine percent of BT and 64% of sham subjects achieved changes in AQLQ of 0.5 or greater (PPS, 99.6%). Six percent more BT subjects were hospitalized in the treatment period (up to 6 wk after BT). In the posttreatment period (6-52 wk after BT), the BT group experienced fewer severe exacerbations, emergency department (ED) visits, and days missed from work/school compared with the sham group (PPS, 95.5, 99.9, and 99.3%, respectively). CONCLUSIONS BT in subjects with severe asthma improves asthma-specific quality of life with a reduction in severe exacerbations and healthcare use in the posttreatment period. Clinical trial registered with www.clinialtrials.gov (NCT00231114).
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Affiliation(s)
- Mario Castro
- Washington University School of Medicine, Campus Box 8052, 660 S. Euclid, St. Louis, MO 63110-1093, USA.
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