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Juber NF, Hofbauer LM, Rodriguez FS. Associations between asthma and cognitive functioning among older adults. Does the age of asthma diagnosis matter? Results from the RAND IFLS-5 study. J Asthma 2024:1-11. [PMID: 38805388 DOI: 10.1080/02770903.2024.2361785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/26/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To assess the associations of asthma status or age at asthma diagnosis with cognition using the Telephone Survey of Cognitive Status from a large population-based sample. Further, we investigated the possibility that asthma treatment mediates these associations. METHODS This is a cross-sectional study from the Indonesian Family Life Survey Fifth Wave (IFLS-5) collected in 2014-2015. A weighted linear regression model was used to examine the associations between asthma and cognitive functioning scores in adults aged 50 years or older. Of the 6660 total samples included in this study, 176 participants had asthma (2.6%). We controlled for age, sex, and urbanicity with further adjustments for adult covariates or childhood covariates, as appropriate. RESULTS There was no association between overall asthma status and cognitive functioning scores. However, asthma diagnosed at 0-19 years was associated with significantly higher cognitive functioning scores (Beta coefficient = 2.24, 95% CI: 0.62 - 0.87), compared to those without asthma. In the analysis involving current treatment status (restricted analysis), the significant association disappeared among those under current asthma treatment status, indicating that asthma treatment may mediate the association. CONCLUSION Asthma might not be a risk factor for cognitive impairment. Observations of a significant association of pediatric asthma with higher cognitive scores need further investigation. Understanding cognitive functioning among older adults with asthma may improve the surveillance of cognitive decline inthis age group.
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Affiliation(s)
- Nirmin F Juber
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- German Center for Neurodegenerative Diseases (DZNE), Psychosocial Epidemiology and Public Health Research Group, Greifswald, Germany
| | - Lena M Hofbauer
- German Center for Neurodegenerative Diseases (DZNE), Psychosocial Epidemiology and Public Health Research Group, Greifswald, Germany
| | - Francisca S Rodriguez
- German Center for Neurodegenerative Diseases (DZNE), Psychosocial Epidemiology and Public Health Research Group, Greifswald, Germany
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2
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Tattersall MC, Jarjour NN, Busse PJ. Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:849-862. [PMID: 38355013 PMCID: PMC11219096 DOI: 10.1016/j.jaip.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities and highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extrapulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.
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Affiliation(s)
- Matthew C Tattersall
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Paula J Busse
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY
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3
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Abuaish S, Eltayeb H, Bepari A, Hussain SA, Alqahtani RS, Alshahrani WS, Alqahtani AH, Almegbil NS, Alzahrani WN. The Association of Asthma with Anxiety, Depression, and Mild Cognitive Impairment among Middle-Aged and Elderly Individuals in Saudi Arabia. Behav Sci (Basel) 2023; 13:842. [PMID: 37887495 PMCID: PMC10604786 DOI: 10.3390/bs13100842] [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: 08/09/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Asthma is a common chronic inflammatory condition with increasing global prevalence. There is some evidence highlighting the effect of asthma on brain functioning. In Saudi Arabia, limited studies have examined the relationship between asthma and mental health, including cognition and mood disorders in older adults in particular. In this study, we examine the association between asthma and mental health outcomes in middle-aged and elderly individuals in Riyadh, Saudi Arabia. In a cross-sectional study, 243 subjects were recruited from outpatient clinics between 2020-2021 (non-asthmatic: n = 159, asthmatic: n = 84). The Montreal Cognitive Assessment test, the Hospital Anxiety and Depression Scale, and the Asthma Control Test were used to assess cognition, anxiety and depression, and asthma control, respectively. Logistic regression analysis while controlling for covariates revealed an association between asthma and symptoms of anxiety and depression (OR = 2.40 [95% CI: 1.07-5.35]) and mild cognitive impairment (MCI) (OR = 1.80 [95% CI: 1.00-3.24]). Poorly controlled asthma increased the odds of anxiety cases (OR = 4.88 [95% CI: 1.09-17.2]). Stratifying analysis by age intervals revealed that asthma was associated with symptoms of anxiety and depression (OR = 2.5 [95% CI: 1.00-6.08]) in middle-aged patients only, while elderly asthmatics had increased odds of having MCI (OR = 7.4 [95% CI: 2.34-23.31]). These findings highlight the possible effects of asthma and its control on mental health among middle-aged and elderly individuals in Saudi Arabia.
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Affiliation(s)
- Sameera Abuaish
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Huda Eltayeb
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Asmatanzeem Bepari
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Syed Arif Hussain
- Respiratory Care Department, College of Applied Sciences, Almaarefa University, Riyadh 13713, Saudi Arabia;
| | - Raneem Saad Alqahtani
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Waad Saeed Alshahrani
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Amjad Hayf Alqahtani
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Nada Saad Almegbil
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
| | - Wafa Nedal Alzahrani
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (H.E.); (A.B.); (R.S.A.); (W.S.A.); (A.H.A.); (N.S.A.); (W.N.A.)
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4
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Wang Y, Mou YK, Wang HR, Song XY, Wei SZ, Ren C, Song XC. Brain response in asthma: the role of "lung-brain" axis mediated by neuroimmune crosstalk. Front Immunol 2023; 14:1240248. [PMID: 37691955 PMCID: PMC10484342 DOI: 10.3389/fimmu.2023.1240248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
In addition to typical respiratory symptoms, patients with asthma are frequently accompanied by cognitive decline, mood disorders (anxiety and depression), sleep disorders, olfactory disorders, and other brain response manifestations, all of which worsen asthma symptoms, form a vicious cycle, and exacerbate the burden on families and society. Therefore, studying the mechanism of neurological symptoms in patients with asthma is necessary to identify the appropriate preventative and therapeutic measures. In order to provide a comprehensive reference for related research, we compiled the pertinent literature, systematically summarized the latest research progress of asthma and its brain response, and attempted to reveal the possible "lung-brain" crosstalk mechanism and treatment methods at the onset of asthma, which will promote more related research to provide asthmatic patients with neurological symptoms new hope.
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Affiliation(s)
- Yao Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
| | - Ya-Kui Mou
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
| | - Han-Rui Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiao-Yu Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
| | - Shi-Zhuang Wei
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
| | - Chao Ren
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Innovation and Practice Base for Postdoctors, Yantai Yuhuangding Hospital, Yantai, China
- Department of Neurology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xi-Cheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Innovation and Practice Base for Postdoctors, Yantai Yuhuangding Hospital, Yantai, China
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Kroll JL, Ritz T. Asthma, the central nervous system, and neurocognition: Current findings, potential mechanisms, and treatment implications. Neurosci Biobehav Rev 2023; 146:105063. [PMID: 36708797 DOI: 10.1016/j.neubiorev.2023.105063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
Accumulating behavioral evidence suggests that asthma is associated with cognitive deficits. A number of studies have identified potential biological contributions to cognition in asthma; however, mechanistic pathways of central nervous system (CNS) involvement in asthma are yet to be established. We therefore conducted a literature review to identify studies examining potential CNS contributions to cognition in asthma. In this review, we discuss our general understanding of the CNS in asthma in the context of cognitive performance and outline a working model of mechanistic pathways linking the proposed neural influences of asthma pathology with cognition. To this extent, we incorporate neural, behavioral, psychological, social and environmental factors. Finally, we underscore the clinical significance of the CNS and neurocognitive sequelae in asthma, highlighting potential opportunities for routine monitoring, therapeutic intervention, and recommend key areas for future research.
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Affiliation(s)
- Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, USA; Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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6
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Mokhtari-Zaer A, Hosseini M, Roshan NM, Boskabady MH. Treadmill exercise ameliorates memory deficits and hippocampal inflammation in ovalbumin-sensitized juvenile rats. Brain Res Bull 2020; 165:40-47. [PMID: 32998022 DOI: 10.1016/j.brainresbull.2020.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/29/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
The behavioral changes, including spatial learning and memory impairment as well as depressive- and anxiety-like behaviors in an animal model of asthma were demonstrated previously. On the other hand, there is increasing evidence that the anti-inflammatory actions of exercise are related to their neuroprotective properties against different insults in the brain. This study was aimed to explore the effects of moderate treadmill exercise on cognitive deficits and possible anti-inflammatory mechanisms in ovalbumin (OVA)-sensitized rats. The exercise groups were trained to run on the treadmill 30 min/day with an intensity of 12 m/min, 5 days/week for 4 weeks. Animals in the OVA groups were sensitized by two intraperitoneal (i.p.) injections of OVA (10 μg/injection) and challenged with OVA by inhalation during the treadmill running exercise period. Passive avoidance (PA) memory, levels of interleukin (IL)-10 and tumor necrosis factor (TNF)-α in the hippocampus, total and differential white blood cell (WBC) count in the blood as well as pathological changes of the lung were then evaluated. OVA-sensitization was resulted in cognitive deficits in the PA task, along with increased total and differential WBC in blood and TNF-α in the hippocampus. However, exercise ameliorated these changes and increased the IL-10 level in the hippocampus, suggesting that moderate treadmill exercise can improve memory impairment in OVA-sensitized rats due to its anti-inflammatory properties.
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Affiliation(s)
- Amin Mokhtari-Zaer
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahmoud Hosseini
- Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nama Mohammadian Roshan
- Department of Pathology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Boskabady
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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7
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Veeranki SP, Downer B, Jupiter D, Kuo YF, Raji M, Calhoun W, Wong R. Chronic Respiratory Disease and Cognitive Impairment in Older Mexican Adults. Neurol India 2020; 67:1539-1542. [PMID: 31857556 DOI: 10.4103/0028-3886.273646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Cognitive impairment has emerged as an important concern in clinical practice in aging population. Several comorbid factors contribute to etiopathogenesis; one disease of interest is chronic respiratory disease. Aim The aim of this study is to investigate the association of chronic respiratory disease with risk of cognitive impairment in older Mexicans. Materials and Methods Data were obtained from 2782 Mexicans, aged ≥60 years, enrolled in waves I (2001) and III (2012) of the Mexican Health and Aging Study, a prospective cohort of nationally representative sample of older Mexicans. Participants' self-reported responses were used to categorize them into having respiratory disease or not. Study outcome included participants categorized into "cognitively impaired" or "cognitively normal" groups. Multivariable logistic regression models were used to investigate the relationship. Results Overall, 16% of cohort participants reported cognitively impaired at Wave III. Compared with older Mexicans without chronic respiratory disease diagnosis, those diagnosed were not significantly associated with risk of cognitive impairment [adjusted odds ratio (OR): 0.94, 95% confidence interval (CI): 0.58-1.58]. Conclusion Chronic respiratory disease is not significantly associated with risk of cognitive impairment in older Mexican adults.
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Affiliation(s)
- Sreenivas P Veeranki
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Brian Downer
- Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Daniel Jupiter
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila Raji
- Division of Geriatrics, University of Texas Medical Branch, Galveston, Texas, USA
| | - William Calhoun
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Rebeca Wong
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
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8
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Li S, Lv P, He M, Zhang W, Liu J, Gong Y, Wang T, Gong Q, Ji Y, Lui S. Cerebral regional and network characteristics in asthma patients: a resting-state fMRI study. Front Med 2020; 14:792-801. [PMID: 32270434 DOI: 10.1007/s11684-020-0745-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023]
Abstract
Asthma is a serious health problem that involves not only the respiratory system but also the central nervous system. Previous studies identified either regional or network alterations in patients with asthma, but inconsistent results were obtained. A key question remains unclear: are the regional and neural network deficits related or are they two independent characteristics in asthma? Answering this question is the aim of this study. By collecting resting-state functional magnetic resonance imaging from 39 patients with asthma and 40 matched health controls, brain functional measures including regional activity (amplitude of low-frequency fluctuations) and neural network function (degree centrality (DC) and functional connectivity) were calculated to systematically characterize the functional alterations. Patients exhibited regional abnormities in the left angular gyrus, right precuneus, and inferior temporal gyrus within the default mode network. Network abnormalities involved both the sensorimotor network and visual network with key regions including the superior frontal gyrus and occipital lobes. Altered DC in the lingual gyrus was correlated with the degree of airway obstruction. This study elucidated different patterns of regional and network changes, thereby suggesting that the two parameters reflect different brain characteristics of asthma. These findings provide evidence for further understanding the potential cerebral alterations in the pathophysiology of asthma.
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Affiliation(s)
- Siyi Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Peilin Lv
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Min He
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wenjing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jieke Liu
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yao Gong
- Department of Geriatric Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, 610036, China
| | - Ting Wang
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yulin Ji
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Tangirala NC, O'Conor R, Wolf MS, Wisnivesky JP, Federman AD. Validity of the Medication Adherence Rating Scale for Adherence to Inhaled Corticosteroids among Older Adults with Asthma or Chronic Obstructive Pulmonary Disease. COPD 2020; 17:74-80. [PMID: 31948266 DOI: 10.1080/15412555.2020.1712688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Regular use of inhaled corticosteroids (ICS) is the standard of care for patients with persistent asthma and chronic obstructive pulmonary disease (COPD). Adherence to ICS is measured using the 10-item Medication Adherence Report Scale (MARS), a self-reported medication adherence assessment. However, data on the validity of this measure are limited. Data were obtained from two cohort studies that examined the association of health literacy with self-management behaviors among adults ages 65 and older with asthma and adults ages 40 and older with COPD. ICS adherence was objectively measured over a 4-week period using electronic monitoring devices. Adequate adherence by MARS assessment was defined as a score ≥4.5, and by electronic monitoring as ≥80% of doses prescribed. We assessed the criterion validity using correlations between self-reported adherence and electronic adherence. Receiver Operating Characteristic (ROC) curve analysis was performed between the two measures. Among patients with asthma, the continuous values for adherence measured by self-report and electronically were weakly correlated (r = 0.33, p < 0.001); similarly, the agreement between the dichotomized measures was weak (kappa 0.30, p=.49). Findings were similar for COPD patients: r = 0.26, p = 0.003; kappa 0.19, p = .60. Area under curve (AUC) values generated from ROC analysis was 0.69 and 0.61, for asthma and COPD patients, respectively. Commonly used measure for adherence performed weakly compared to electronic monitoring in separate populations of patients with asthma and COPD. Investigators measuring self-reported medication adherence among patients with these pulmonary diseases should consider using alternative instruments or using objective measures exclusively.
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Affiliation(s)
- Neelima C Tangirala
- Division of General Internal Medicine, 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
| | - 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
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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SHINKE HARUKO, KAMIRYO HIROSHI, UMEZAWA KANOKO, HORI SUYA, NAKATA KYOSUKE, NAGANO TATSUYA, HAZEKI NOBUKO, KOBAYASHI KAZUYUKI, FUKABORI TAKASHI, NISHIMURA YOSHIHIRO. Questionnaire Survey for Bronchial Asthma in Elderly Care Facilities. THE KOBE JOURNAL OF MEDICAL SCIENCES 2019; 64:E174-E179. [PMID: 30988264 PMCID: PMC6668589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Abstract
In developed countries such as North America, the decline in mortality from bronchial asthma has ceased since 2006. The decline in mortality rate is also decreasing in Japan, where about 1,500 asthma deaths have been reported. Among these, elderly people aged 65 years or over account for about 90% of cases. Therefore, the treatment of elderly patients with asthma is an important subject. However, few studies have been conducted on asthma in elderly patients. In this survey, we distributed a questionnaire to 253 elderly care facilities in Kobe, Japan. Ninety facilities responded, and 223 patients in 70 out of 90 facilities were diagnosed with asthma. Dry powder inhaler was the most commonly used dosage form of inhaled corticosteroids. Many facilities have patients who need some assistance during inhalation: only 60% of facilities reported that inhalation is performed accurately. While 31 facilities had patients with a history of hospitalization for asthma attacks, only 14 of these facilities were able to provide appropriate initial treatment. Many facilities have difficulty providing assistance with inhalation to elderly patients whose cognitive function has deteriorated. This survey highlights challenges experienced by care facilities in treating asthma in the elderly.
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Affiliation(s)
- HARUKO SHINKE
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - HIROSHI KAMIRYO
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - KANOKO UMEZAWA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - SUYA HORI
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - KYOSUKE NAKATA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - TATSUYA NAGANO
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - NOBUKO HAZEKI
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - KAZUYUKI KOBAYASHI
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - YOSHIHIRO NISHIMURA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Sonney J, Insel KC. Exploring the intersection of executive function and medication adherence in school-age children with asthma. J Asthma 2018. [PMID: 29513610 DOI: 10.1080/02770903.2018.1441870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma. OBJECTIVE The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma. METHODS Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning. RESULTS Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = -3.84, p =. 001, and shifting, t (30) = -3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence. CONCLUSIONS This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.
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Affiliation(s)
- Jennifer Sonney
- a Department of Family and Child Nursing , School of Nursing, University of Washington , Seattle , WA
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12
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Bian R, Zhang Y, Yang Y, Yin Y, Zhao X, Chen H, Yuan Y. White Matter Integrity Disruptions Correlate With Cognitive Impairments in Asthma. J Magn Reson Imaging 2018; 48:748-756. [PMID: 29356252 DOI: 10.1002/jmri.25946] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairments are common in asthma, which is a serious global health problem characterized by chronic airway inflammation. However, the underlying neuromechanism is still unclear. PURPOSE/HYPOTHESIS To investigate the neuromechanism underlying cognitive impairments of asthma. We hypothesized that asthma patients exhibit altered white matter (WM) microstructures, which may contribute to their cognitive impairments. STUDY TYPE Case-control study. SUBJECTS 37 patients with asthma (14 male) and 31 healthy controls (10 male). FIELD STRENGTH/SEQUENCE Diffusion tensor imaging (DTI) covering the whole brain was acquired on a 3.0T scanner using a single-shot echo planar imaging sequence. ASSESSMENT A DTI with tract-based spatial statistics (TBSS) approach was used to investigate the whole-brain differences in the WM fractional anisotropy (FA) values. STATISTICAL TESTS Demographic and neuropsychological data were performed using two independent sample t-test or chi-square test or Mann-Whitney rank test. The relationship between cognitive impairments and WM abnormalities was studied using correlation analyses. RESULTS Impairments of language ability, executive function, and visual-spatial processing and widespread WM disruptions reflected by FA reduction were found in asthma patients. The executive function was related to left forceps major, cingulum, and right uncinate fasciculus, ILF (inferior longitudinal fasciculus) positively (P < 0.05). FA abnormalities were positively correlated with duration of asthma and asthma control test (ACT) scores. DATA CONCLUSION Asthma patients display multiple cognitive impairments and universally WM integrity disruptions, among which executive dysfunction closely correlates with WM abnormalities. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Rongrong Bian
- Medical School of Southeast University, Department of Psychosomatics and Psychiatry, Zhongda Hospital, Nanjing, China
| | - Yuqun Zhang
- Medical School of Southeast University, Department of Psychosomatics and Psychiatry, Zhongda Hospital, Nanjing, China
| | - Yuan Yang
- Medical School of Southeast University, Department of Psychosomatics and Psychiatry, Zhongda Hospital, Nanjing, China
| | - Yingying Yin
- Medical School of Southeast University, Department of Psychosomatics and Psychiatry, Zhongda Hospital, Nanjing, China
| | | | - Huanxin Chen
- Key Laboratory of Cognition and Personality, Ministry of Education; School of Psychology, Southwest University, Chongqing, China
| | - Yonggui Yuan
- Medical School of Southeast University, Department of Psychosomatics and Psychiatry, Zhongda Hospital, Nanjing, China
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Zhang Y, Yang Y, Wang Z, Bian R, Jiang W, Yin Y, Yue Y, Hou Z, Yuan Y. Altered Regional Cerebral Blood Flow of Right Cerebellum Posterior Lobe in Asthmatic Patients With or Without Depressive Symptoms. Front Psychiatry 2018; 9:225. [PMID: 29892237 PMCID: PMC5985698 DOI: 10.3389/fpsyt.2018.00225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/08/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Asthma is a chronic disease appeared to be associated with depression. But the underpinnings of depression in asthma remain unknown. In order to understand the neural mechanisms of depression in asthma, we used cerebral blood flow (CBF) to probe the difference between depressed asthmatic (DA) and non-depressed asthmatic (NDA) patients. Methods: Eighteen DA patients, 24 NDA patients and 57 healthy controls (HC) received pulsed arterial spin labeling (pASL) scan for measuring CBF, resting-state functional magnetic resonance imaging (rs-fMRI) scan, severity of depression and asthma control assessment, respectively. Results: Compared to NDA, DA patients showed increased regional CBF (rCBF) in the right cerebellum posterior lobe. Compared to HC, DA, and NDA patients all showed significantly decreased rCBF in the right cerebellum posterior lobe. Conclusions: We showed the first evidence of altered rCBF in the right cerebellum posterior lobe in asthma using pASL, which appeared to be involved in the neuropathology in asthma. Clinical Trial Registration: An investigation of therapeutic mechanism in asthmatic patients: based on the results of Group Cognitive Behavioral Therapy (Registration number: ChiCTR-COC-15007442) (http://www.chictr.org.cn/usercenter.aspx).
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Affiliation(s)
- Yuqun Zhang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Yuan Yang
- Department of Respiration, ZhongDa Hospital, Southeast University, Nanjing, China
| | - Ze Wang
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
| | - Rongrong Bian
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Yingying Yin
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Yingying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Zhenghua Hou
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Psychosomatics, School of Medicine, Southeast University, Nanjing, China
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Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? A meta-analytic review. J Clin Exp Neuropsychol 2017; 39:965-978. [PMID: 28325118 DOI: 10.1080/13803395.2017.1288802] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators. METHOD Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls. RESULTS There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications. CONCLUSIONS There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.
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Affiliation(s)
- Farzin Irani
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Jordan Mark Barbone
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Janet Beausoleil
- b Division of Allergy and Immunology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Lynn Gerald
- c Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , AZ , USA.,d Asthma and Airways Disease Research Center , University of Arizona , Tucson , AZ , USA
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Ouellette DR, Lavoie KL. Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:639-650. [PMID: 28243081 PMCID: PMC5317263 DOI: 10.2147/copd.s123994] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes.
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Affiliation(s)
- Daniel R Ouellette
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kim L Lavoie
- Montreal Behavioral Medicine Center (MBMC), Research Center, Integrated University Health and Social Services Center - Sacred Heart Hospital of Montreal, Montreal, QC, Canada
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Hur GY, Ye YM, Moon SY, Kim JH, Jung KS, Park HS. Impact of cognitive impairment on asthma control in older asthmatics. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Gyu-Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Min Ye
- Department of Allergy and Immunology, Ajou University School of Medicine, Suwon, Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Joo-Hee Kim
- Department of Pulmonary & Allergy, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
| | - Ki-Suck Jung
- Department of Pulmonary & Allergy, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
| | - Hae-Sim Park
- Department of Allergy and Immunology, Ajou University School of Medicine, Suwon, Korea
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Melo-Neto JSD, Stroppa-Marques AEZ, Gomes FDC. Profile of Pneumopathic Elderly Persons Admitted to a Pulmonary Rehabilitation Center. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Pneumopathies are defined as a group of respiratory diseases. Physiotherapy centers are a conventional treatment option which can help prevent and treat various pulmonary conditions. Objective: To characterize elderly persons with pneumopathies admitted for pulmonary rehabilitation. Methods: 84 elderly persons were admitted for pulmonary rehabilitation. Patients diagnosed with pulmonary disease and aged ≥60 years were included in the study. The following variables were analyzed: gender, age, marital status, profession, medical diagnosis, main medical complaint, associated diseases, and cardiovascular risk factors. Results: The most common lung disease is chronic obstructive pulmonary disease (COPD) (26.2%). Women showed a greater association with asthma [odds ratio (OR)=5.875; p=0.010]. Dyspnea was the most prevalent main complaint among this population (50%). Among the main complaints, difficulty walking was more associated with men (OR=2.85; p=0.055). Strokes were the main disease most commonly associated with pneumopathies (12.1%). Women had a greater association with other diseases (OR=5.34, p=0.068), especially when two diseases were presented simultaneously with lung disease (OR=2.32, p=0.041). Among the risk factors, physical inactivity (OR=3.33), alcohol consumption (OR=0.046) and history of smoking (OR=3.00) were significantly associated with men, while depression (OR=5.67) was significantly associated with women. Women exhibited a 3.28 greater association between allergies and pneumopathies than men (p=0.013). The practice of physical activity was more associated with women (OR=3.89; p=0.03). Osteoporosis was more prevalent among elderly women with pulmonary disease (OR=10.75; p<0.0001), and was also significantly associated with a history of smoking (OR=4.31; p=0.009). Conclusion: The most frequent diagnosis, main complaint and associated disease were COPD, dyspnea and strokes, respectively. Elderly woman exhibited a greater association with the diagnosis of bronchial asthma, and more diseases associated with lung disease. Physical inactivity, difficulty walking, and a history of alcohol consumption and smoking are more associated with men, while depression, the presence of allergies, regular physical activity and osteoporosis are more associated with women. Thus, the results demonstrate that these individuals have specific characteristics.
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Cleutjens FAHM, Pedone C, Janssen DJA, Wouters EFM, Incalzi RA. Sleep quality disturbances and cognitive functioning in elderly patients with COPD. ERJ Open Res 2016; 2:00054-2016. [PMID: 27957482 PMCID: PMC5140015 DOI: 10.1183/23120541.00054-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/18/2016] [Indexed: 02/03/2023] Open
Abstract
Information about the association between cognitive functions, such as copying function, and sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) is lacking. This cross-sectional observational study aimed to investigate the association between copying function and self-reported sleep quality disturbances and disease severity in an elderly COPD population. Cognitive function performances, assessed using the Mini-Mental State Examination, were compared in 562 ambulatory COPD patients with and without sleep disturbances; assessed using the Established Populations for Epidemiologic Studies of the Elderly questionnaire; and stratified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades. Sleep disturbances overall were not correlated with cognitive functioning. A trend was revealed towards worse design copying in patients with sleep disturbances overall. GOLD I patients with difficulties falling asleep and nocturnal awakenings had worse copying ability compared to GOLD I patients without these sleep disturbances. Copying ability was worse for GOLD III than GOLD I, orientation was worse for GOLD II than GOLD I and language was worse for GOLD II and III than GOLD I. To conclude, sleep disturbances seem to be a weak correlate of cognitive functioning, and are not a marker of disease severity. Sleep disturbances are a weak correlate of cognitive functioning in COPDhttp://ow.ly/gUhD301PvcQ
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Affiliation(s)
- Fiona A H M Cleutjens
- Dept of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Claudio Pedone
- Dept of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Daisy J A Janssen
- Dept of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Dept of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
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Xu KY, Wisnivesky JP, Martynenko M, Mhango G, Busse PJ, Wolf MS, Holguin F, Federman AD. Assessing the association of obesity and asthma morbidity in older adults. Ann Allergy Asthma Immunol 2016; 117:33-7. [PMID: 27234936 DOI: 10.1016/j.anai.2016.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity is a robust predictor of poor asthma control in younger adults. Given the high prevalence of asthma and obesity in older Americans, weight reduction could benefit asthma management in this population. OBJECTIVE To assess the association between obesity and asthma outcomes among older adults. METHODS We recruited from urban primary care clinics a prospective cohort of nonsmoking individuals with asthma who were 60 years or older without a history of other respiratory diseases. At baseline, body mass index (BMI) measurements were classified as normal (BMI, 18-25), overweight (BMI, 25-30), or obese (BMI, >30). Measures of asthma morbidity (Asthma Control Questionnaire [ACQ], and Mini Asthma Quality of Life Questionnaire [Mini-AQLQ]) and asthma-related resource utilization (inpatient or outpatient) were taken at baseline and at 3- and 12-month interviews. We used generalized estimating equation models to assess associations between obesity and asthma outcomes after controlling for potential confounders. RESULTS Of the 437 older adults with asthma in the study, 17% had a normal BMI, 32% were overweight, and 51% were obese. Unadjusted analyses revealed that obesity was associated with lower ACQ scores (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09-1.31) and poorer Mini-AQLQ scores (OR, 1.21; 95% CI, 1.11-1.33). Adjusted analyses revealed no significant association between obesity and ACQ (OR, 1.05; 95% CI, 0.96-1.15) and Mini-AQLQ (OR, 1.08; 95% CI, 0.99-1.19). CONCLUSION Our study suggests that obesity is not independently associated with worse asthma outcomes in older adults, reflecting potential differences in the mechanisms that link obesity with asthma control in older vs younger populations.
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Affiliation(s)
- Kevin Y Xu
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York; Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Martynenko
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paula J Busse
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fernando Holguin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alex D Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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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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