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Al Okla SM, Al Rasbi FAZK, Al Marhubi HS, Al Mataani SS, Al Sawai YM, Mohammed HI, Al Mamari MAS, Al Balushi SAA, Abbady AQ. The Impact of Air Pollution on Asthma Severity among Residents Living near the Main Industrial Complex in Oman: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:553. [PMID: 38791768 PMCID: PMC11121288 DOI: 10.3390/ijerph21050553] [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: 03/09/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Asthma is a widespread chronic respiratory disease that poses a significant public health challenge. The current study investigated the associations between air pollution and asthma severity among individuals residing near the Sohar industrial port (SIP) in Oman. Despite the presence of multiple major industrial complexes in Oman, limited knowledge regarding their impact on respiratory health is accredited. Hence, the primary objective of this study is to offer valuable insights into the respiratory health consequences of industrial air pollution in Al Batinah North. METHODS The state health clinics' records for patient visits related to asthma were collected for the timeframe spanning 2014 to 2022. Exposure was defined as the distance from the SIP, Majan Industerial Area (MIA), and Sohar Industerial Zone (SIZ) to determine high-, intermediate-, and low-exposure zones (<6 km, 6-12 km and >12 km, respectively). Exposure effect modifications by age, gender, and smoking status were also examined. RESULTS The conducted cross-sectional study of 410 patients (46.1% males and 53.9% females) living in over 17 areas around SIP revealed that 73.2% of asthmatics were under 50 years old, with severity significantly associated with closeness to the port. Risk ratios were estimated to be (RR:2.42; CI95%: 1.01-5.78), (RR:1.91; CI95%: 1.01-3.6), and (RR:1.68; CI95%: 0.92-3.09) for SIP, MIP, and SIZ areas, respectively, compared to the control area. Falaj Al Qabail (6.4 km) and Majees (6 km) had the highest number of asthma patients (N 69 and N 72) and highest percentages of severe asthma cases among these patients (28% and 24%) with significant risk ratios (RR:2.97; CI95%: 1.19-7.45 and RR:2.55; CI95%: 1.00-6.48), correspondingly. Moreover, severe asthma prevalence peaked in the 25-50 age group (RR:2.05; CI95%: 1.26-3.33), and this linkage between asthma and age was much more pronounced in males than females. Smoking and exposure to certain contaminants (dust and smoke) also increased the risk of severe asthma symptoms, but their effects were less important in the high-risk zone, suggesting much more important risk factors. A neural network model accurately predicted asthma risk (94.8% accuracy), with proximity to SIP as the most influential predictor. CONCLUSIONS This study highlights the high asthma burden near SIP, linked to port proximity, smoking, and wind direction as major risk factors. These findings inform vital public health policies to reduce air pollution and improve respiratory health in the region, prompting national policy review.
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Affiliation(s)
- Souad Mahmoud Al Okla
- College of Medicine and Health Sciences, National University of Science and Technology, P.O. Box 391, Sohar 321, Oman; (F.A.Z.K.A.R.); (H.S.A.M.); (S.S.A.M.); (Y.M.A.S.)
- Department of Biology, Faculty of Sciences, Damascus University, Damascus P.O. Box 30621, Syria
| | - Fatima Al Zahra Khamis Al Rasbi
- College of Medicine and Health Sciences, National University of Science and Technology, P.O. Box 391, Sohar 321, Oman; (F.A.Z.K.A.R.); (H.S.A.M.); (S.S.A.M.); (Y.M.A.S.)
| | - Hawida Said Al Marhubi
- College of Medicine and Health Sciences, National University of Science and Technology, P.O. Box 391, Sohar 321, Oman; (F.A.Z.K.A.R.); (H.S.A.M.); (S.S.A.M.); (Y.M.A.S.)
| | - Shima Salim Al Mataani
- College of Medicine and Health Sciences, National University of Science and Technology, P.O. Box 391, Sohar 321, Oman; (F.A.Z.K.A.R.); (H.S.A.M.); (S.S.A.M.); (Y.M.A.S.)
| | - Yusra Mohammed Al Sawai
- College of Medicine and Health Sciences, National University of Science and Technology, P.O. Box 391, Sohar 321, Oman; (F.A.Z.K.A.R.); (H.S.A.M.); (S.S.A.M.); (Y.M.A.S.)
| | - Hasa Ibrahim Mohammed
- Liwa Extended Health Center, Ministry of Health, Liwa 325, Oman; (H.I.M.); (M.A.S.A.M.)
| | | | | | - Abdul Qader Abbady
- Division of Molecular Biomedicine, Department of Molecular Biology and Biotechnology, Atomic Energy Commission of Syria (AECS), Damascus P.O. Box 6091, Syria;
- Department of Biology and Medical Science, Faculty of Pharmacy, International University for Science and Technology (IUST), Damascus, Syria
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Zarate-Gonzalez G, Brown P, Cisneros R. Costs of Air Pollution in California's San Joaquin Valley: A Societal Perspective of the Burden of Asthma on Emergency Departments and Inpatient Care. J Asthma Allergy 2024; 17:369-382. [PMID: 38645669 PMCID: PMC11032670 DOI: 10.2147/jaa.s455745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The San Joaquin Valley (SJV) is often recognized as one of the most polluted regions in the US. Periods of pollution exposure are associated with increased health burden related to respiratory inflammation and undermined lung function, which aggravates respiratory diseases such as asthma and leads to symptoms such as coughing, wheezing, or difficulty breathing. Asthma costs US$ 82 billion annually in healthcare costs, missed work and school in the US. Methods Employing a societal perspective, a cost of illness design was combined with environmental epidemiological methods to analyze the economic impact of O3, NO2, and PM2.5-related adverse respiratory health outcomes amongst SJV residents who attended the emergency department (ED) or were hospitalized in 2016. Results Asthma exacerbations monetized value ranged from US$ 3353 to US$ 5003 per ED visit and for hospital admissions US$ 2584 per inpatient day for adults 65 years and older to US$ 3023 per child. The estimated value to society in healthcare costs, productivity losses, school absences, and opportunity costs from air pollution adverse health outcomes totaled US$ 498,014,124 in ED visits and US$ 223,552,720 in hospital admissions for the SJV population in 2016. The marginal reduction in the background concentrations of pollutants would avert 21,786 ED adverse events and 19,328 hospitalizations from the health burden on the SJV population or US$ 8,024,505 cost savings due to O3, US$ 82,482,683 from NO2 reductions, and US$ 46,214,702 from decreased concentration of PM2.5. Conclusion This study provides evidence that air pollution is a negative externality that imposes substantial social, environmental, and healthcare costs on the SJV. Furthermore, the region would avert significant adverse health outcomes realizing economic savings by reducing air pollution and exposures.
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Affiliation(s)
| | - Paul Brown
- Department of Public Health, University of California, Merced, CA, USA
| | - Ricardo Cisneros
- Department of Public Health, University of California, Merced, CA, USA
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Sommer B, González-Ávila G, Flores-Soto E, Montaño LM, Solís-Chagoyán H, Romero-Martínez BS. Phytoestrogen-Based Hormonal Replacement Therapy Could Benefit Women Suffering Late-Onset Asthma. Int J Mol Sci 2023; 24:15335. [PMID: 37895016 PMCID: PMC10607548 DOI: 10.3390/ijms242015335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
It has been observed that plasmatic concentrations of estrogens, progesterone, or both correlate with symptoms in asthmatic women. Fluctuations in female sex steroid concentrations during menstrual periods are closely related to asthma symptoms, while menopause induces severe physiological changes that might require hormonal replacement therapy (HRT), that could influence asthma symptoms in these women. Late-onset asthma (LOA) has been categorized as a specific asthmatic phenotype that includes menopausal women and novel research regarding therapeutic alternatives that might provide relief to asthmatic women suffering LOA warrants more thorough and comprehensive analysis. Therefore, the present review proposes phytoestrogens as a promising HRT that might provide these females with relief for both their menopause and asthma symptoms. Besides their well-recognized anti-inflammatory and antioxidant capacities, phytoestrogens activate estrogen receptors and promote mild hormone-like responses that benefit postmenopausal women, particularly asthmatics, constituting therefore a very attractive potential therapy largely due to their low toxicity and scarce side effects.
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Affiliation(s)
- Bettina Sommer
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias ‘Ismael Cosio Villegas’, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City CP 14080, Mexico
| | - Georgina González-Ávila
- Laboratorio de Oncología Biomédica, Departamento de Enfermedades Crónico Degenerativas, Instituto Nacional de Enfermedades Respiratorias ‘Ismael Cosio Villegas’, Mexico City CP 14080, Mexico;
| | - Edgar Flores-Soto
- Departmento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico; (E.F.-S.); (L.M.M.); (B.S.R.-M.)
| | - Luis M. Montaño
- Departmento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico; (E.F.-S.); (L.M.M.); (B.S.R.-M.)
| | - Héctor Solís-Chagoyán
- Neurociencia Cognitiva Evolutiva, Centro de Investigación en Ciencias Cognitivas, Universidad Autónoma del Estado de Morelos, Cuernavaca CP 62209, Morelos, Mexico;
| | - Bianca S. Romero-Martínez
- Departmento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico; (E.F.-S.); (L.M.M.); (B.S.R.-M.)
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Challenges in the Management of Asthma in Older Adults. CURRENT TREATMENT OPTIONS IN ALLERGY 2023. [DOI: 10.1007/s40521-023-00331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Suzukawa M, Ohta K, Hashimoto H, Oyamada Y, Miki M, Ogawara M, Inoue Y, Saito AM, Fukutomi Y, Kobayashi N, Taniguchi M. Characterization and cluster analyses of elderly asthma in comparison with nonelderly patients with asthma in Japan. Ann Allergy Asthma Immunol 2023; 130:607-616.e3. [PMID: 36657562 DOI: 10.1016/j.anai.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Asthma is a heterogeneous disease with multiple phenotypes that are useful in precision medicine. As the population ages, the elderly asthma (EA, aged ≥ 65 years) population is growing, and EA is now a major health problem worldwide. OBJECTIVE To characterize EA and identify its phenotypes. METHODS In adult patients with asthma (aged ≥ 18 years) who had been diagnosed with having asthma at least 1 year before study enrollment, 1925 were included in the NHOM-Asthma (registered in UMIN-CTR; UMIN000027776), and the data were used for this study, JFGE-Asthma (registered in UMIN-CTR; UMIN000036912). Data from EA and non-EA (NEA) groups were compared, and Ward's minimum-variance hierarchical clustering method and principal component analysis were performed. RESULTS EA was characterized by older asthma onset, longer asthma duration and smoking history, more comorbidities, lower pulmonary function, less atopic, lower adherence, and more hospital admissions because of asthma. In contrast, the number of eosinophils, total immunoglobulin E level, oral corticosteroid use, and asthma control questionnaire scores were equivalent between EA and NEA. There were 3 distinct phenotypes in EA, which are as follows: EA1: youngest, late onset, short duration, mild; EA2: early onset, long duration, atopic, low lung function, moderate; and EA3: oldest, eosinophilic, overweight, low lung function, most severe. The classification factors of the EA phenotypes included the age of onset and asthma control questionnaire-6. Similarities were observed between EA and NEA phenotypes after principal component analysis. CONCLUSION The EA in Japan may be unique because of the population's high longevity. Characterization of EA phenotypes from the present cohort indicated the need for distinct precision medicine for EA. TRIAL REGISTRATION JFGE-Asthma registered in UMIN-CTR (https://www.umin.ac.jp/ctr/); UMIN000036912.
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Affiliation(s)
- Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Japan Anti-Tuberculosis Association, JATA Fukujuji Hospital, Tokyo, Japan
| | - Hiroya Hashimoto
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Mari Miki
- Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Mitsumasa Ogawara
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuma Fukutomi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | | | - Masami Taniguchi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Shonan Kamakura General Hospital, Kanagawa, Japan
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Schiffers C, Wouters EFM, Breyer-Kohansal R, Buhl R, Pohl W, Irvin CG, Breyer MK, Hartl S. Asthma Prevalence and Phenotyping in the General Population: The LEAD (Lung, hEart, sociAl, boDy) Study. J Asthma Allergy 2023; 16:367-382. [PMID: 37063243 PMCID: PMC10094413 DOI: 10.2147/jaa.s402326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023] Open
Abstract
Background Asthma is a chronic heterogeneous respiratory disease involving differential pathophysiological pathways and consequently distinct asthma phenotypes. Objective and Methods In the LEAD Study, a general population cohort (n=11.423) in Vienna ranging from 6-82 years of age, we addressed the prevalence of asthma and explored inflammatory asthma phenotypes that included allergic and non-allergic asthma, and within these phenotypes, an eosinophilic (eosinophils ≥300 cells/µL, or ≥150 cells/µL in the presence of ICS medication) or non-eosinophilic (eosinophils <300 cells/µL, or <150 cells/µL in the presence of ICS) phenotype. In addition, we compared various factors related to biomarkers, body composition, lung function, and symptoms in control subjects versus subjects with current asthma (current doctor's diagnosis of asthma). Results An overall prevalence of 4.6% was observed for current asthma. Furthermore, an age-dependent shift from allergic to non-allergic asthma was found. The non-eosinophilic phenotype was more prominent. Obesity was a prevalent condition, and body composition including visceral adipose tissue (VAT), is affected in current asthma versus controls. Conclusion This broad-aged and large general population cohort identified differential patterns of inflammatory asthma phenotypes that were age-dependent. The presence of eosinophilia was associated with worse asthma control, increased asthma medication, increased VAT, and lower lung function, the opposite was found for the presence of an allergic asthma.
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Affiliation(s)
- Caspar Schiffers
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Correspondence: Caspar Schiffers, Ludwig Boltzmann Institute for Lung Health, Vienna, 1140, Austria, Email
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
| | - Roland Buhl
- Pulmonology Department, Mainz University Hospital, Mainz, Germany
| | - Wolfgang Pohl
- Karl Landsteiner Gesellschaft, Institute for Clinical and Experimental Pneumology, Vienna, Austria
| | - Charles G Irvin
- Pulmonary and Critical Care, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
- Sigmund Freud University, Faculty for Medicine, Vienna, Austria
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Choi BS, Taslakian EN, Wi CI, Shin YH, Seol HY, Ryu E, Boyce TG, Johnson JN, King KS, Kwon JH, Juhn YJ. Atopic asthma as a potentially significant but unrecognized risk factor for Kawasaki disease in children. J Asthma 2022; 59:1767-1775. [PMID: 34347558 PMCID: PMC8885770 DOI: 10.1080/02770903.2021.1963765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Childhood asthma is known to be associated with risks of both respiratory and non-respiratory infections. Little is known about the relationship between asthma and the risk of Kawasaki disease (KD). We assessed associations of asthma status and asthma phenotype (e.g. atopic asthma) with KD. METHODS We performed a population-based retrospective case-control study, using KD cases between January 1, 1979, and December 31, 2016, and two matched controls per case. KD cases were defined by the American Heart Association diagnostic criteria. Asthma status prior to KD (or control) index dates was ascertained by the two asthma criteria, Predetermined Asthma Criteria (PAC) and Asthma Predictive Index (API, a surrogate phenotype of atopic asthma). We assessed whether 4 phenotypes (both PAC + and API+; PAC + only; API + only, and non-asthmatics) were associated with KD. RESULTS There were 124 KD cases during the study period. The group having both PAC + and API + was significantly associated with the increased odds of KD, compared to non-asthmatics (odds ratio [OR] 4.3; 95% CI: 1.3 - 14.3). While asthma defined by PAC was not associated with KD, asthma defined by PAC positive with eosinophilia (≥4%) was significantly associated with the increased odds of KD (OR: 6.7; 95% CI: 1.6 - 28.6) compared to non-asthmatics. Asthma status defined by API was associated with KD (OR = 4.7; 95% CI: 1.4-15.1). CONCLUSIONS Atopic asthma may be associated with increased odds of KD. Further prospective studies are needed to determine biological mechanisms underlying the association between atopic asthma and increased odds of KD.
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Affiliation(s)
- Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea
- Precision Population Medicine Lab, Mayo Clinic, Rochester, Minnesota
| | - Editt Nikoyan Taslakian
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington
| | - Chung-Il Wi
- Precision Population Medicine Lab, Mayo Clinic, Rochester, Minnesota
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Hee Yun Seol
- Precision Population Medicine Lab, Mayo Clinic, Rochester, Minnesota
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Thomas G. Boyce
- Department of Pediatrics, Levine Children’s Hospital, Charlotte, North Carolina
| | - Jonathan N. Johnson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katherine S. King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jung Hyun Kwon
- Precision Population Medicine Lab, Mayo Clinic, Rochester, Minnesota
- Department of Pediatrics, Korea University, College of Medicine, Seoul, Korea
| | - Young J. Juhn
- Precision Population Medicine Lab, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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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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Seol HY, Shrestha P, Muth JF, Wi CI, Sohn S, Ryu E, Park M, Ihrke K, Moon S, King K, Wheeler P, Borah B, Moriarty J, Rosedahl J, Liu H, McWilliams DB, Juhn YJ. Artificial intelligence-assisted clinical decision support for childhood asthma management: A randomized clinical trial. PLoS One 2021; 16:e0255261. [PMID: 34339438 PMCID: PMC8328289 DOI: 10.1371/journal.pone.0255261] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Clinical decision support (CDS) tools leveraging electronic health records (EHRs) have been an approach for addressing challenges in asthma care but remain under-studied through clinical trials. OBJECTIVES To assess the effectiveness and efficiency of Asthma-Guidance and Prediction System (A-GPS), an Artificial Intelligence (AI)-assisted CDS tool, in optimizing asthma management through a randomized clinical trial (RCT). METHODS This was a single-center pragmatic RCT with a stratified randomization design conducted for one year in the primary care pediatric practice of the Mayo Clinic, MN. Children (<18 years) diagnosed with asthma receiving care at the study site were enrolled along with their 42 primary care providers. Study subjects were stratified into three strata (based on asthma severity, asthma care status, and asthma diagnosis) and were blinded to the assigned groups. MEASUREMENTS Intervention was a quarterly A-GPS report to clinicians including relevant clinical information for asthma management from EHRs and machine learning-based prediction for risk of asthma exacerbation (AE). Primary endpoint was the occurrence of AE within 1 year and secondary outcomes included time required for clinicians to review EHRs for asthma management. MAIN RESULTS Out of 555 participants invited to the study, 184 consented for the study and were randomized (90 in intervention and 94 in control group). Median age of 184 participants was 8.5 years. While the proportion of children with AE in both groups decreased from the baseline (P = 0.042), there was no difference in AE frequency between the two groups (12% for the intervention group vs. 15% for the control group, Odds Ratio: 0.82; 95%CI 0.374-1.96; P = 0.626) during the study period. For the secondary end points, A-GPS intervention, however, significantly reduced time for reviewing EHRs for asthma management of each participant (median: 3.5 min, IQR: 2-5), compared to usual care without A-GPS (median: 11.3 min, IQR: 6.3-15); p<0.001). Mean health care costs with 95%CI of children during the trial (compared to before the trial) in the intervention group were lower than those in the control group (-$1,036 [-$2177, $44] for the intervention group vs. +$80 [-$841, $1000] for the control group), though there was no significant difference (p = 0.12). Among those who experienced the first AE during the study period (n = 25), those in the intervention group had timelier follow up by the clinical care team compared to those in the control group but no significant difference was found (HR = 1.93; 95% CI: 0.82-1.45, P = 0.10). There was no difference in the proportion of duration when patients had well-controlled asthma during the study period between the intervention and the control groups. CONCLUSIONS While A-GPS-based intervention showed similar reduction in AE events to usual care, it might reduce clinicians' burden for EHRs review resulting in efficient asthma management. A larger RCT is needed for further studying the findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02865967.
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Affiliation(s)
- Hee Yun Seol
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Pragya Shrestha
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Joy Fladager Muth
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kathy Ihrke
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sungrim Moon
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Katherine King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Philip Wheeler
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bijan Borah
- Department of Health Service Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jordan Rosedahl
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Deborah B. McWilliams
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Young J. Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
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Lee DW, Han CW, Hong YC, Oh JM, Bae HJ, Kim S, Lim YH. Long-term exposure to fine particulate matter and incident asthma among elderly adults. CHEMOSPHERE 2021; 272:129619. [PMID: 33465612 DOI: 10.1016/j.chemosphere.2021.129619] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
RATIONALE Although an association of fine particulate matter (PM2.5) with asthma incidence has been assumed, there is insufficient evidence regarding the effect of long-term exposure to PM2.5 on incident asthma among elderly adults. OBJECTIVES This study aimed to investigate an association between long-term exposure to PM2.5 and incident asthma among elderly adults in South Korea. METHODS Adults ≥65 years of age (n = 1,220,645) who did not visit hospitals for asthma during a washout period (between 2008 and 2010) were followed up until 2016 using data from the National Health Insurance System in South Korea. Incident asthma was defined as the number of patients with a primary diagnostic code of asthma who visited hospitals more than twice. We linked the health data with district-level PM2.5 concentrations and estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident asthma after adjusting for potential confounders in time-varying Cox proportional hazard models. MEASUREMENTS AND MAIN RESULTS Over 5,942,256 person-years, 54,522 patients developed asthma, with an incidence of 9.2 cases/1000 person-years. A 10 μg/m3 increase in the 36-month mean PM2.5 concentration was significantly associated with a 9% increase in incident asthma (HR = 1.09, 95% CI: 1.04-1.14). This association was found to be robust for different definitions of incident asthma and washout periods. CONCLUSION Long-term exposure to PM2.5 was associated with the incidence of asthma in elderly adults. This finding provides evidence of an association between PM2.5 and adult-onset asthma.
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Affiliation(s)
- Dong-Wook Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Woo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Oh
- Department of Occupational and Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyun-Joo Bae
- Korea Environment Institute, Sejong, Republic of Korea
| | - Soontae Kim
- Department of Environmental and Safety Engineering, Ajou University, Suwon, Republic of Korea
| | - Youn-Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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11
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Quirce S, Heffler E, Nenasheva N, Demoly P, Menzies-Gow A, Moreira-Jorge A, Nissen F, Hanania NA. Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy. J Asthma Allergy 2020; 13:743-752. [PMID: 33408487 PMCID: PMC7781019 DOI: 10.2147/jaa.s282205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particularly women, present with asthma for the first time in adult life, tend to be non-allergic and often require higher doses of inhaled corticosteroids (ICS) or are relatively refractory to corticosteroid treatment. In this review, we examine the published literature improve the understanding of the following aspects of LOA: 1) the age cut-off for its diagnosis; 2) its distinct clinical phenotypes, characteristics and risk factors; and 3) its association with allergic comorbidities and conditions. Overall, our review reveals that clinicians and researchers have used multiple age cut-offs to define LOA, with cut-off ages ranging from >12 years to ≥65 years. LOA has also been classified into several distinct phenotypes, some of which drastically differ in their clinical characteristics, course and prognosis. Although LOA has traditionally been considered non-allergic in nature, our review indicates that it is commonly associated with allergic features and comorbidities. Our findings suggest that there is an urgent need for the development of more clear clinical practice guidelines that can provide more clarity on the definition and other aspects of LOA. In addition, the association of LOA and allergy needs to be re-examined to frame a more optimal treatment strategy for patients with LOA.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Natalia Nenasheva
- Department of Allergology and Immunology of Russian Medical Academy for Continuous Medical Education, Moscow, Russian Federation
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | | | - Francis Nissen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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12
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Langer S, Horn J, Kluttig A, Mikolajczyk R, Karrasch S, Schulz H, Wichmann HE, Linseisen J, Jaeschke L, Pischon T, Fricke J, Keil T, Ahrens W, Günther K, Kuß O, Schikowski T, Schmidt B, Jöckel KH, Michels KB, Franzke CW, Becher H, Jagodzinski A, Castell S, Kemmling Y, Lieb W, Waniek S, Wirkner K, Löffler M, Kaaks R, Greiser KH, Berger K, Legath N, Meinke-Franze C, Schipf S, Leitzmann M, Baurecht H, Weigl K, Amitay E, Gottschick C. [Occurrence of bronchial asthma and age at initial asthma diagnosis-first results of the German National Cohort]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:397-403. [PMID: 32125462 DOI: 10.1007/s00103-020-03105-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA. MATERIAL AND METHODS Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex. RESULTS In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated. CONCLUSION The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.
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Affiliation(s)
- Susan Langer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland
| | - Johannes Horn
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland
| | - Alexander Kluttig
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland
| | - Stefan Karrasch
- Institut für Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, München, Deutschland.,Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland.,Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München, Deutschland
| | - Holger Schulz
- Institut für Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, München, Deutschland.,Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München, Deutschland
| | - Heinz-Erich Wichmann
- Institut für Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, München, Deutschland
| | - Jakob Linseisen
- Ludwig-Maximilians-Universität München, Lehrstuhl für Epidemiologie, UNIKA-T Augsburg, Augsburg, Deutschland.,Klinische Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, München, Deutschland
| | - Lina Jaeschke
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland
| | - Tobias Pischon
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland.,Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnerstandort Berlin, Berlin, Deutschland.,MDC/BIH Biobank, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC) und Berlin Institute of Health (BIH), Berlin, Deutschland
| | - Julia Fricke
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Thomas Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, Berlin, Deutschland.,Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland.,Landesinstitut für Gesundheit, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Deutschland
| | - Wolfgang Ahrens
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Institut für Statistik, Fachbereich Mathematik und Informatik, Universität Bremen, Bremen, Deutschland
| | - Kathrin Günther
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland
| | - Oliver Kuß
- Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum (DDZ), Düsseldorf, Deutschland
| | - Tamara Schikowski
- IUF - Leibniz-Institut für umweltmedizinische Forschung gGmbH, Düsseldorf, Deutschland
| | - Börge Schmidt
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Karin B Michels
- Institut für Prävention und Tumorepidemiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claus-Werner Franzke
- Institut für Prävention und Tumorepidemiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Heiko Becher
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Annika Jagodzinski
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg - Eppendorf, Hamburg, Deutschland.,Deutsches Zentrum für Herzkreislaufforschung, Hamburg, Deutschland.,Epidemiologisches Studienzentrum, Universitätsklinikum Hamburg - Eppendorf, Hamburg, Deutschland
| | - Stefanie Castell
- Helmholtz-Zentrum für Infektionsforschung, Braunschweig, Deutschland
| | - Yvonne Kemmling
- Helmholtz-Zentrum für Infektionsforschung, Braunschweig, Deutschland
| | - Wolfgang Lieb
- Institut für Epidemiologie, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Sabina Waniek
- Institut für Epidemiologie, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Kerstin Wirkner
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Leipzig, Deutschland.,LIFE-Forschungszentrum für Zivilisationskrankheiten, Universität Leipzig, Leipzig, Deutschland
| | - Markus Löffler
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Leipzig, Deutschland.,LIFE-Forschungszentrum für Zivilisationskrankheiten, Universität Leipzig, Leipzig, Deutschland
| | - Rudolf Kaaks
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Karin Halina Greiser
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Nicole Legath
- Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Claudia Meinke-Franze
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Sabine Schipf
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Michael Leitzmann
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Hansjörg Baurecht
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Korbinian Weigl
- Abt. Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Efrat Amitay
- Abt. Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Cornelia Gottschick
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland.
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13
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Trivedi M, Denton E. Asthma in Children and Adults-What Are the Differences and What Can They Tell us About Asthma? Front Pediatr 2019; 7:256. [PMID: 31294006 PMCID: PMC6603154 DOI: 10.3389/fped.2019.00256] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/06/2019] [Indexed: 12/30/2022] Open
Abstract
Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
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Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Eve Denton
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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14
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Seol HY, Sohn S, Liu H, Wi CI, Ryu E, Park MA, Juhn YJ. Early Identification of Childhood Asthma: The Role of Informatics in an Era of Electronic Health Records. Front Pediatr 2019; 7:113. [PMID: 31001500 PMCID: PMC6454104 DOI: 10.3389/fped.2019.00113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
Emerging literature suggests that delayed identification of childhood asthma results in an increased risk of long-term and various morbidities compared to those with timely diagnosis and intervention, and yet this risk is still overlooked. Even when children and adolescents have a history of recurrent asthma-like symptoms and risk factors embedded in their medical records, this information is sometimes overlooked by clinicians at the point of care. Given the rapid adoption of electronic health record (EHR) systems, early identification of childhood asthma can be achieved utilizing (1) asthma ascertainment criteria leveraging relevant clinical information embedded in EHR and (2) innovative informatics approaches such as natural language processing (NLP) algorithms for asthma ascertainment criteria to enable such a strategy. In this review, we discuss literature relevant to this topic and introduce recently published informatics algorithms (criteria-based NLP) as a potential solution to address the current challenge of early identification of childhood asthma.
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Affiliation(s)
- Hee Yun Seol
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, United States
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine and Internal Medicine, Mayo Clinic, Rochester, MN, United States
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15
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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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16
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Alzaabi A, Idrees M, Behbehani N, Khaitov MR, Tunceli K, Urdaneta E, Awad N, Safwat M. Cross-sectional study on Asthma Insights and Management in the Gulf and Russia. Allergy Asthma Proc 2018; 39:430-436. [PMID: 30326990 DOI: 10.2500/aap.2018.39.4180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Asthma is a chronic and complex lung disease that is not completely understood. It involves airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness. The most common symptoms are recurrent wheezing, chest tightness, shortness of breath, and coughing. Objective: The Asthma Insights and Management study gathered information on the burden of asthma in the Gulf region (United Arab Emirates, Kuwait, Saudi Arabia) and Russia. Methods: This was a cross-sectional, multinational, noninterventional, two-phase study that collected data from patients ages ≥ 12 years, through interviews and a survey questionnaire. Phase 1 consisted of survey questions focused on estimating the asthma prevalence in the community. Phase 2 was designed to assess the level of asthma control, asthma-related perceptions and behaviors, and presentation patterns. Data were summarized by using descriptive analyses. Results: Analysis of data of 711 patients revealed that the prevalence of asthma among patients who lived in the community was 7.9% and that 66% subjectively perceived their asthma as being controlled. However, 97% of the patients' asthma were partially controlled or uncontrolled based on the Global initiative for Asthma control classification. Troubling symptoms were daytime coughing (33.3%) and shortness of breath (20.3%). With respect to medications for asthma, 76.2% of the patients reported the use of quick relief medication and 80.8% of maintenance medication during the past 4 weeks. Asthma exacerbation in the past year was reported by 40% of adults and adolescents in the study. Conclusion: The results showed that a significant proportion of the patients experienced bothersome symptoms and that many had a lack of knowledge about asthma control and treatment recommendations, which indicated that there is a need for improvements in patient education and asthma care in the Gulf and Russia regions.
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Affiliation(s)
- Ashraf Alzaabi
- From the Division of Respirology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Majdy Idrees
- Pulmonary Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Musa R. Khaitov
- Immunology Department, National Research Center Institute of Immunology, Federal Medical Biological Agency, Moscow, Russia
| | - Kaan Tunceli
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey
| | - Eduardo Urdaneta
- Global Medical Affairs, Merck & Co. Inc., Kenilworth, New Jersey
| | - Nancy Awad
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
| | - Mohamed Safwat
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
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17
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New-Onset Asthma in Adults: What Does the Trigger History Tell Us? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:898-905.e1. [PMID: 30240884 DOI: 10.1016/j.jaip.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adult-onset asthma is an important asthma phenotype and, in contrast to childhood asthma, is often associated with specific triggers of onset. It is unknown whether these triggers correspond with specific phenotypic characteristics or predict a specific asthma outcome. OBJECTIVE To compare clinical, functional, and inflammatory characteristics between patients with different triggers of asthma onset, and relate these triggers to asthma outcome. METHODS Two hundred adults with recently diagnosed (<1 year) asthma were prospectively followed for 5 years. The trigger of asthma onset was patient reported and defined by the question: "What, in your opinion, elicited your asthma?" Asthma remission was defined as no asthma symptoms and no asthma medication use for ≥1 year. Kruskal-Wallis and Fisher's exact test were used to compare categories containing >10 patients. RESULTS Ten categories of triggers were identified, of which 5 contained >10 patients. Clinical and inflammatory characteristics and remission rates differed significantly between categories. "New allergic sensitization" (11%) was associated with mild atopic asthma and a relatively young age at onset; "pneumonia" (8%) with previous smoking, low IgE, and the highest remission rates (one third); "upper respiratory symptoms" (22%) with high exhaled NO and eosinophilia; "no trigger identified" (38%) did not show any specific characteristics; and "stressful life event" (7%) with high medication usage, low type 2 markers, and no disease remission. CONCLUSIONS Patients with adult-onset asthma can be characterized by the trigger that seemingly incited their asthma. These triggers might represent underlying mechanisms and may be important to phenotype patients and predict disease outcome.
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18
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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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19
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Gemicioglu B, Bayram H, Cimrin A, Abadoglu O, Cilli A, Uzaslan E, Gunen H, Akyildiz L, Suerdem M, Ozlu T, Misirligil Z. Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey. J Asthma 2018; 56:553-561. [PMID: 29714602 DOI: 10.1080/02770903.2018.1471707] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients. METHODS This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months. RESULTS Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly. CONCLUSIONS Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.
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Affiliation(s)
- Bilun Gemicioglu
- a Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Hasan Bayram
- b Department of Pulmonary Diseases, Koç University , Medical School
| | - Arif Cimrin
- c Department of Pulmonary Diseases, Faculty of Medicine , Dokuz Eylul University , Izmir , Turkey
| | - Oznur Abadoglu
- d Department of Pulmonary Diseases, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Aykut Cilli
- e Department of Pulmonary Diseases, Faculty of Medicine , Akdeniz University , Antalya , Turkey
| | - Esra Uzaslan
- f Department of Pulmonary Diseases, Faculty of Medicine , Uludag University , Bursa , Turkey
| | - Hakan Gunen
- g Department of Pulmonary Diseases , Sureyyapasa Pulmonary Diseases Hospital and Research Center , Istanbul , Turkey
| | - Levent Akyildiz
- h Department of Pulmonary Diseases , Memorial Dicle Hospital , Diyarbakir , Turkey
| | - Mecit Suerdem
- i Department of Pulmonary Diseases, Faculty of Medicine , Selcuk University , Konya , Turkey
| | - Tevfik Ozlu
- j Department of Pulmonary Diseases, Faculty of Medicine , Karadeniz Teknik University , Trabzon , Turkey
| | - Zeynep Misirligil
- k Department of Pulmonary Diseases, Faculty of Medicine , Ankara University , Ankara , Turkey
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20
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Baptist AP, Busse PJ. Asthma Over the Age of 65: All's Well That Ends Well. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:764-773. [PMID: 29747982 PMCID: PMC5951417 DOI: 10.1016/j.jaip.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
Asthma in older adults (often classified as those 65 years or older) is relatively common, underdiagnosed, and suboptimally treated. It is an important health problem, as the population of the United States continues to age. Unfortunately, asthma morbidity and mortality rates are highest in this age group. Alterations in the innate and adaptive immune responses occur with aging, and contribute to pathophysiologic differences and subsequent treatment challenges. The symptoms of asthma may differ from those in younger populations, and often include fatigue. There are unique factors that can complicate asthma management among older adults, including comorbidities, menopause, caregiver roles, and depression. Pharmacologic therapies are often not as effective as in younger populations, and may have greater side effects. Spirometry, peak flow measurements, and asthma education are typically underused, and may contribute to delays in diagnosis as well as worse outcomes. There are specific strategies that health care providers can take to improve the care of older adults with asthma.
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Affiliation(s)
- Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Paula J Busse
- Icahn School of Medicine at Mount Sinai, New York, NY
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21
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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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Dunn RM, Busse PJ, Wechsler ME. Asthma in the elderly and late-onset adult asthma. Allergy 2018; 73:284-294. [PMID: 28722758 DOI: 10.1111/all.13258] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/26/2022]
Abstract
Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related physiologic and immunologic changes that complicate the presentation, diagnosis, and management of asthma in the aged population. Evidence suggests that elderly asthmatics are more likely to be underdiagnosed and undertreated. Additionally, elderly patients with asthma have highest rates of morbidity and mortality from their disease than younger patients. The underlying airway inflammation of asthma in this age group likely differs from younger patients and is felt to be non-type 2 mediated. While elderly patients are underrepresented in clinical trials, subgroup analysis of large clinical trials suggests they may be less likely to respond to traditional asthma therapies (ie, corticosteroids). As the armamentarium of pharmacologic asthma therapies expands, it will be critical to include elderly asthmatics in large clinical trials so that therapy may be better tailored to this at-risk and growing population.
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Affiliation(s)
- R. M. Dunn
- Department of Pulmonary and Critical Care Medicine; University of Colorado School of Medicine; Aurora CO USA
- National Jewish Health; Denver CO USA
| | - P. J. Busse
- Division of Clinical Immunology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. E. Wechsler
- Department of Pulmonary and Critical Care Medicine; National Jewish Health; Denver CO USA
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23
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Patel B, Wi CI, Hasassri ME, Divekar R, Absah I, Almallouhi E, Ryu E, King K, Juhn YJ. Heterogeneity of asthma and the risk of celiac disease in children. Allergy Asthma Proc 2018; 39:51-58. [PMID: 29279060 DOI: 10.2500/aap.2018.39.4100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although human leukocyte antigen (HLA)-DR and HLA-DQ genes and gluten play crucial roles in developing celiac disease (CD), most patients with these risk factors still do not develop CD, which indicates additional unrecognized risk factors. OBJECTIVE To determine the association between asthma and the risk of CD in children. METHODS We conducted a population-based retrospective case-control study in children who resided in Olmsted County, Minnesota. We identified children with CD (cases) between January 1, 1997, and December 31, 2014, and compared these with children without CD (controls) (1:2 matching). Asthma status was ascertained by using the predetermined asthma criteria (PAC) and the asthma predictive index (API). Data analysis included conditional logistic regression models and an unsupervised network analysis by using an independent phenome-wide association scan (PheWAS) data set. RESULTS Although asthma status as determined by using PAC was not associated with the risk of CD (odds ratio [OR] 1.4 [95% confidence interval {CI}, 0.8-2.5]; p = 0.2), asthma status by using the API was significantly associated (OR 2.8 [95% CI, 1.3-6.0]; p = 0.008). A subgroup analysis indicated that children with both asthma as determined by using PAC and a family history of asthma had an increased risk of CD compared with those without asthma (OR 2.28 [95% CI, 1.11-4.67]; p = 0.024). PheWAS data showed a cluster of asthma single nucleotide polymorphisms and patients with CD. CONCLUSION A subgroup of children with asthma who also had a family history of asthma seemed to be at an increased risk of CD, and, thus, the third factor that underlies the risk of CD might be related to genetic factors for asthma. Heterogeneity of asthma plays a role in determining the risk of asthma-related comorbidity.
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Wi CI, Sohn S, Ali M, Krusemark E, Ryu E, Liu H, Juhn YJ. Natural Language Processing for Asthma Ascertainment in Different Practice Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:126-131. [PMID: 28634104 PMCID: PMC5733699 DOI: 10.1016/j.jaip.2017.04.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We developed and validated NLP-PAC, a natural language processing (NLP) algorithm based on predetermined asthma criteria (PAC) for asthma ascertainment using electronic health records at Mayo Clinic. OBJECTIVE To adapt NLP-PAC in a different health care setting, Sanford Children Hospital, by assessing its external validity. METHODS The study was designed as a retrospective cohort study that used a random sample of 2011-2012 Sanford Birth cohort (n = 595). Manual chart review was performed on the cohort for asthma ascertainment on the basis of the PAC. We then used half of the cohort as a training cohort (n = 298) and the other half as a blind test cohort to evaluate the adapted NLP-PAC algorithm. Association of known asthma-related risk factors with the Sanford-NLP algorithm-driven asthma ascertainment was tested. RESULTS Among the eligible test cohort (n = 297), 160 (53%) were males, 268 (90%) white, and the median age was 2.3 years (range, 1.5-3.1 years). NLP-PAC, after adaptation, and the human abstractor identified 74 (25%) and 72 (24%) subjects, respectively, with 66 subjects identified by both approaches. Sensitivity, specificity, positive predictive value, and negative predictive value for the NLP algorithm in predicting asthma status were 92%, 96%, 89%, and 97%, respectively. The known risk factors for asthma identified by NLP (eg, smoking history) were similar to the ones identified by manual chart review. CONCLUSIONS Successful implementation of NLP-PAC for asthma ascertainment in 2 different practice settings demonstrates the feasibility of automated asthma ascertainment leveraging electronic health record data with a potential to enable large-scale, multisite asthma studies to improve asthma care and research.
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Affiliation(s)
- Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Mir Ali
- Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD
| | - Elizabeth Krusemark
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn.
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25
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Sohn S, Wang Y, Wi CI, Krusemark EA, Ryu E, Ali MH, Juhn YJ, Liu H. Clinical documentation variations and NLP system portability: a case study in asthma birth cohorts across institutions. J Am Med Inform Assoc 2017; 25:353-359. [PMID: 29202185 PMCID: PMC7378885 DOI: 10.1093/jamia/ocx138] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To assess clinical documentation variations across health care institutions using different electronic medical record systems and investigate how they affect natural language processing (NLP) system portability. Materials and Methods Birth cohorts from Mayo Clinic and Sanford Children’s Hospital (SCH) were used in this study (n = 298 for each). Documentation variations regarding asthma between the 2 cohorts were examined in various aspects: (1) overall corpus at the word level (ie, lexical variation), (2) topics and asthma-related concepts (ie, semantic variation), and (3) clinical note types (ie, process variation). We compared those statistics and explored NLP system portability for asthma ascertainment in 2 stages: prototype and refinement. Results There exist notable lexical variations (word-level similarity = 0.669) and process variations (differences in major note types containing asthma-related concepts). However, semantic-level corpora were relatively homogeneous (topic similarity = 0.944, asthma-related concept similarity = 0.971). The NLP system for asthma ascertainment had anF-score of 0.937 at Mayo, and produced 0.813 (prototype) and 0.908 (refinement) when applied at SCH. Discussion The criteria for asthma ascertainment are largely dependent on asthma-related concepts. Therefore, we believe that semantic similarity is important to estimate NLP system portability. As the Mayo Clinic and SCH corpora were relatively homogeneous at a semantic level, the NLP system, developed at Mayo Clinic, was imported to SCH successfully with proper adjustments to deal with the intrinsic corpus heterogeneity.
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Affiliation(s)
- Sunghwan Sohn
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Yanshan Wang
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Mir H Ali
- Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Boulet LP, Robitaille C, Deschesnes F, Villeneuve H, Boulay MÈ. Comparative Clinical, Physiological, and Inflammatory Characteristics of Elderly Subjects With or Without Asthma and Young Subjects With Asthma. Chest 2017; 152:1203-1213. [PMID: 28941741 DOI: 10.1016/j.chest.2017.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asthma seems to present in the elderly as a specific phenotype that remains to be further described. In this prospective observational study, we aimed to assess the multidimensional aspects of asthma in the elderly. METHODS In young (18 to 35 years old) subjects with mild to moderate asthma and elderly subjects (aged ≥60 years) either with or without mild to moderate asthma, we compared asthma control, health care and medication use, lung function, markers of airway and systemic inflammation, and adherence to therapy. RESULTS Fifty subjects were recruited in each group. Elderly people with asthma showed more marked airway obstruction compared with young people with asthma and elderly people without asthma. They also had poorer asthma control, mainly associated with a lower FEV1, compared with young people with asthma, although airway responsiveness, health care use, prescribed doses of inhaled corticosteroids, and adherence to treatment were similar in both groups. Elderly subjects had an increase in some markers of systemic inflammation and bronchial epithelial dysfunction compared with young people with asthma. Blood eosinophils were higher in both asthma groups, particularly in elderly people with asthma. Sputum neutrophils were increased in both groups of elderly subjects and sputum eosinophils were increased in elderly people with asthma compared with the other two groups. CONCLUSIONS Asthma in the elderly presents as a specific phenotype associated with increased airway obstruction and mixed airway inflammation in addition to signs of systemic inflammation.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada.
| | - Catherine Robitaille
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Francine Deschesnes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Hélène Villeneuve
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Marie-Ève Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
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Wi CI, Sohn S, Rolfes MC, Seabright A, Ryu E, Voge G, Bachman KA, Park MA, Kita H, Croghan IT, Liu H, Juhn YJ. Application of a Natural Language Processing Algorithm to Asthma Ascertainment. An Automated Chart Review. Am J Respir Crit Care Med 2017; 196:430-437. [PMID: 28375665 DOI: 10.1164/rccm.201610-2006oc] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Difficulty of asthma ascertainment and its associated methodologic heterogeneity have created significant barriers to asthma care and research. OBJECTIVES We evaluated the validity of an existing natural language processing (NLP) algorithm for asthma criteria to enable an automated chart review using electronic medical records (EMRs). METHODS The study was designed as a retrospective birth cohort study using a random sample of 500 subjects from the 1997-2007 Mayo Birth Cohort who were born at Mayo Clinic and enrolled in primary pediatric care at Mayo Clinic Rochester. Performance of NLP-based asthma ascertainment using predetermined asthma criteria was assessed by determining both criterion validity (chart review of EMRs by abstractor as a gold standard) and construct validity (association with known risk factors for asthma, such as allergic rhinitis). MEASUREMENTS AND MAIN RESULTS After excluding three subjects whose respiratory symptoms could be attributed to other conditions (e.g., tracheomalacia), among the remaining eligible 497 subjects, 51% were male, 77% white persons, and the median age at last follow-up date was 11.5 years. The asthma prevalence was 31% in the study cohort. Sensitivity, specificity, positive predictive value, and negative predictive value for NLP algorithm in predicting asthma status were 97%, 95%, 90%, and 98%, respectively. The risk factors for asthma (e.g., allergic rhinitis) that were identified either by NLP or the abstractor were the same. CONCLUSIONS Asthma ascertainment through NLP should be considered in the era of EMRs because it can enable large-scale clinical studies in a more time-efficient manner and improve the recognition and care of childhood asthma in practice.
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Affiliation(s)
- Chung-Il Wi
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit
| | - Sunghwan Sohn
- 3 Division of Biomedical Statistics and Informatics, and
| | - Mary C Rolfes
- 2 Asthma Epidemiology Research Unit.,4 Mayo Medical School, Rochester, Minnesota
| | | | - Euijung Ryu
- 3 Division of Biomedical Statistics and Informatics, and
| | - Gretchen Voge
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit.,5 Division of Neonatology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; and
| | - Kay A Bachman
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Miguel A Park
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Hirohito Kita
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Ivana T Croghan
- 7 Department of Medicine Research, Mayo Clinic, Rochester, Minnesota
| | - Hongfang Liu
- 3 Division of Biomedical Statistics and Informatics, and
| | - Young J Juhn
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit
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Abstract
The older population has seen the greatest increase in the prevalence of current asthma in recent years. Asthma may begin at any age and when it occurs at an advanced as opposed to a young age, it is often nonatopic, severe, and unremitting. Unfortunately, geriatric-specific guidelines are not available for the diagnosis and treatment of asthma. However, with objective monitoring, avoidance of asthma triggers, appropriate pharmacotherapy, and patient education, the disease can be managed successfully.
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Affiliation(s)
- Sidney S Braman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box #1232, New York, NY 10029, USA.
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Kim SH, Won HK, Moon SD, Kim BK, Chang YS, Kim KW, Yoon IY. Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study. PLoS One 2017; 12:e0173075. [PMID: 28245272 PMCID: PMC5330513 DOI: 10.1371/journal.pone.0173075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/14/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sleep disordered breathing (SDB) and sleep disturbances have been reported to be associated with allergic rhinitis and asthma. However, population-based studies of this issue in the elderly are rare. OBJECTIVE To investigate the impact of self-reported rhinitis and asthma on sleep apnea and sleep quality using polysomnography in an elderly Korean population. METHODS A total of 348 elderly subjects who underwent one-night polysomnography study among a randomly selected sample were enrolled. Study subjects underwent anthropometric and clinical evaluations. Simultaneously, the prevalence and co-morbid status of asthma and allergic rhinitis, and subjective sleep quality were evaluated using a self-reported questionnaire. RESULTS Ever-diagnosis of allergic rhinitis was significantly more prevalent in subjects with SDB compared with those without SDB. Subjects with an ever-diagnosis of allergic rhinitis showed a higher O2 desaturation index and mean apnea duration. Indices regarding sleep efficiency were affected in subjects with a recent treatment of allergic rhinitis or asthma. Waking after sleep onset was longer and sleep efficiency was lower in subjects who had received allergic rhinitis treatment within the past 12 months. Subjects who had received asthma treatment within the past 12 months showed significantly lower sleep efficiency than others. CONCLUSION Our study indicates that a history of allergic rhinitis is associated with increased risk of SDB in the elderly. Sleep disturbance and impaired sleep efficiency were found in the subjects who had received recent treatment of allergic rhinitis or asthma. Physicians should be aware of the high risk of sleep disorders in older patients with respiratory allergic diseases.
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Affiliation(s)
- Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Sung-Do Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Byung-Keun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ki-Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- * E-mail:
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Sin DD, Miravitlles M, Mannino DM, Soriano JB, Price D, Celli BR, Leung JM, Nakano Y, Park HY, Wark PA, Wechsler ME. What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur Respir J 2016; 48:664-73. [PMID: 27338195 DOI: 10.1183/13993003.00436-2016] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/22/2016] [Indexed: 01/10/2023]
Abstract
Patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) have been largely excluded from pivotal therapeutic trials and, as a result, its treatment remains poorly defined and lacking firm evidence. To date, there is no universally accepted definition of ACOS, which has made it difficult to understand its epidemiology or pathophysiology. Despite many uncertainties, there is emerging agreement that some of the key features of ACOS include persistent airflow limitation in symptomatic individuals 40 years of age and older, a well-documented history of asthma in childhood or early adulthood and a significant exposure history to cigarette or biomass smoke. In this perspective, we propose a case definition of ACOS that incorporates these key features in a parsimonious algorithm that may enable clinicians to better diagnose patients with ACOS and most importantly enable researchers to design therapeutic and clinical studies to elucidate its epidemiology and pathophysiology and to ascertain its optimal management strategies.
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Affiliation(s)
- Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, & Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
| | - Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - David M Mannino
- Dept of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, Lexington, KY, USA
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - David Price
- Centre for Academic Primary Care, The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Research in Real-Life, Cambridge, UK
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janice M Leung
- Centre for Heart Lung Innovation, St. Paul's Hospital, & Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, BC, Canada
| | - Yasutaka Nakano
- Dept of Medicine, Division of Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Peter A Wark
- Priority Centre for Healthy Lungs, HMRI University of Newcastle, Newcastle, Australia
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Godinho Netto ACM, Dos Reis TG, Matheus CF, Aarestrup BJV, Aarestrup FM. Fraction of exhaled nitric oxide measurements in the diagnoses of asthma in elderly patients. Clin Interv Aging 2016; 11:623-9. [PMID: 27274212 PMCID: PMC4869629 DOI: 10.2147/cia.s94741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the value of fraction of exhaled nitric oxide (FeNO) measurements in the diagnosis of asthma in elderly patients. Methods The clinical symptoms of 202 elderly patients were assessed with the asthma module of the International Study of Asthma and Allergies in Childhood test, which had been modified for the elderly patients, and the diagnostic routine for chronic obstructive pulmonary disease (COPD), which was based on the Global initiative for chronic Obstructive Lung Disease criteria. Of the 202 patients assessed, 43 were subjected to pulmonary function evaluations (spirometry) and FeNO measurements. Results Of the 202 elderly patients, 34 had asthma (23 definite and eleven probable), 20 met COPD criteria, 13 presented with an overlap of asthma and COPD, and 135 did not fit the criteria for obstructive pulmonary disease. Among the 43 elderly patients who were subjected to FeNO measurements, ten showed altered results (23.2%) and 33 had normal results (76.7%). The average value of FeNO in patients with definite and probable asthma undergoing this procedure was 29.2 parts per billion whereas that in nonasthmatic patients was 17.5 parts per billion (P=0.0002). Conclusion We show a clear relationship between FeNO levels and asthma symptoms and previous asthma diagnoses in elderly patients.
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Affiliation(s)
- Antonio Carlos Maneira Godinho Netto
- School of Medical and Health Sciences - SUPREMA, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil; Maternity Hospital Terezinha de Jesus, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil
| | - Túlio Gonçalves Dos Reis
- School of Medical and Health Sciences - SUPREMA, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil; Maternity Hospital Terezinha de Jesus, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil
| | - Cássia Franco Matheus
- School of Medical and Health Sciences - SUPREMA, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil; Maternity Hospital Terezinha de Jesus, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil
| | - Beatriz Julião Vieira Aarestrup
- Morphology Department, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil; Laboratory of Immunopathology and Experimental Pathology, Federal University of Juiz de Fora, Reproductive Biology Center (CBR), Juiz de Fora, Brazil
| | - Fernando Monteiro Aarestrup
- School of Medical and Health Sciences - SUPREMA, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil; Maternity Hospital Terezinha de Jesus, Federal University of Juiz de Fora, Institute of Biological Sciences, Juiz de Fora, Brazil; Laboratory of Immunopathology and Experimental Pathology, Federal University of Juiz de Fora, Reproductive Biology Center (CBR), Juiz de Fora, Brazil
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Ozturk AB, Iliaz S. Challenges in the management of severe allergic asthma in the elderly. J Asthma Allergy 2016; 9:55-63. [PMID: 27051308 PMCID: PMC4803249 DOI: 10.2147/jaa.s85420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Little is known about the features of asthma and allergy in the elderly. A significant number of elderly patients with asthma have uncontrolled and severe asthma. This review aims to provide an analysis of the literature on the assessment and phenotype of severe allergic asthma in the elderly. Gaps and pitfalls in diagnostic and therapeutic approaches, as well as management of severe allergic asthma in the elderly, are also discussed.
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Affiliation(s)
- Ayse Bilge Ozturk
- Department of Allergy and Immunology, Koç University Hospital, Istanbul, Turkey
| | - Sinem Iliaz
- Department of Pulmonary Medicine, Koç University Hospital, Istanbul, Turkey
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Abstract
Obstructive lung disease includes asthma and chronic obstructive pulmonary disease (COPD). Because a previous issue of Medical Clinics of North America (2012;96[4]) was devoted to COPD, this article focuses on asthma in adults, and addresses some topics about COPD not addressed previously. Asthma is a heterogeneous disease marked by variable airflow obstruction and bronchial hyperreactivity. Onset is most common in early childhood, although many people develop asthma later in life. Adult-onset asthma presents a particular challenge in the primary care clinic because of incomplete understanding of the disorder, underreporting of symptoms, underdiagnosis, inadequate treatment, and high rate of comorbidity.
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Affiliation(s)
- Michael J Lenaeus
- Department of General Internal Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356429, Seattle, WA 98195-6429, USA.
| | - Jan Hirschmann
- Department of General Internal Medicine, Puget Sound VA Medical Center, University of Washington School of Medicine, 1660 South Columbian Way, Seattle, WA 98108, USA
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Thomas M, Wilkinson T. Asthma diagnosis in the community--time for a change? Clin Exp Allergy 2015; 44:1206-9. [PMID: 25243811 DOI: 10.1111/cea.12392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Thomas
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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Hansen S, Probst-Hensch N, Keidel D, Dratva J, Bettschart R, Pons M, Burdet L, Bridevaux PO, Schikowski T, Schindler C, Rochat T, Zemp E. Gender differences in adult-onset asthma: results from the Swiss SAPALDIA cohort study. Eur Respir J 2015. [PMID: 26206877 DOI: 10.1183/13993003.02278-2014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A higher incidence of asthma is reported in women compared with men, but evidence in later adulthood is limited. We aimed to determine the 20-year cumulative incidence of adult asthma in Switzerland and its relation to sex, taking into account age and allergic sensitisation.We assessed incidence of self-report of doctor-diagnosed asthma between 1991/1992 and 2010/2011 in 5128 subjects without asthma, aged 18-60 years at baseline. The age-related probability of asthma onset was analysed by logistic regression adjusting for potential confounders and stratified by sex and allergic sensitisation at baseline.Over 20 years, 128 (5.1%) men and 198 (7.5%) women newly reported doctor-diagnosed asthma. The adjusted odds ratio for female sex was 1.99 (95% CI 1.54-2.57) overall, 3.21 (95% CI 2.12-4.85) among nonsensitised subjects, and 1.43 (95% CI 1.02-2.02) in sensitised subjects. The probability of asthma onset decreased with increasing baseline age in women but not in men. The higher probability of new asthma in sensitised compared with nonsensitised men was unrelated to age, whereas in women it decreased with age.Asthma incidence was higher in women than in men but decreased with increasing age. The female predominance was considerably stronger in nonsensitised adults compared with those with allergic sensitisation.
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Affiliation(s)
- Sofie Hansen
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Dirk Keidel
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Julia Dratva
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | | | - Marco Pons
- Sede Civico, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Luc Burdet
- Dept for Internal Medicine, Hôpital Intercantonal de la Broye, Payerne, Switzerland
| | - Pierre-Olivier Bridevaux
- Service de Pneumologie, Hôpital du Valais (RSV), Centre Hospitalier du Valais Romand, Sion, Switzerland Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Tamara Schikowski
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Christian Schindler
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Thierry Rochat
- Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Elisabeth Zemp
- Dept of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
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Birmingham JM, Gillespie VL, Srivastava K, Li XM, Busse PJ. Influenza A infection enhances antigen-induced airway inflammation and hyperresponsiveness in young but not aged mice. Clin Exp Allergy 2015; 44:1188-99. [PMID: 25039815 DOI: 10.1111/cea.12365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although morbidity and mortality rates from asthma are highest in patients > 65 years of age, the effect of older age on airway inflammation in asthma is not well established. OBJECTIVE To investigate age-related differences in the promotion of allergic inflammation after influenza A viral respiratory infection on antigen-specific IgE production, antigen-induced airway inflammation and airway hyperresponsiveness in mice. METHODS To accomplish this objective, the following model system was used. Young (6 week) and aged (18 months) BALB/c mice were first infected with a non-lethal dose of influenza virus A (H/HKx31). Mice were then ovalbumin (OVA)-sensitized during the acute infection (3-days post inoculation) and then chronically underwent challenge to the airways with OVA. Forty-eight hours after the final OVA challenge, airway hyperresponsiveness (AHR), bronchoalveolar fluid (BALF) cellular and cytokine profile, antigen-specific IgE and IgG1, and lung tissue inflammation were measured. RESULTS Age-specific differences were noted on the effect of a viral infection, allergic sensitization, airway inflammation and airway hyperresponsiveness. Serum OVA-specific IgE was significantly increased in only the aged mice infected with influenza virus. Despite greater morbidity (e.g. weight loss and sickness scores) during the acute infection in the 18-month old mice that were OVA-sensitized, there was little effect on the AHR and BALF cellular differential. In contrast, BALF neutrophils and AHR increased, but eosinophils decreased in 6-week mice that were OVA-sensitized during an acute influenza infection. CONCLUSION With increased age in a mouse model, viral infection prior to antigen sensitization affects the airway and systemic allergic response differently. These differences may reflect distinct phenotypic features of allergic inflammation in older patients with asthma.
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Affiliation(s)
- J M Birmingham
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Larkin EK, Gebretsadik T, Moore ML, Anderson LJ, Dupont WD, Chappell JD, Minton PA, Peebles RS, Moore PE, Valet RS, Arnold DH, Rosas-Salazar C, Das SR, Polack FP, Hartert TV. Objectives, design and enrollment results from the Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure Study (INSPIRE). BMC Pulm Med 2015; 15:45. [PMID: 26021723 PMCID: PMC4506623 DOI: 10.1186/s12890-015-0040-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/16/2015] [Indexed: 12/25/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) during infancy has been consistently associated with an increased risk of childhood asthma. In addition, evidence supports that this relationship is causal. However, the mechanisms through which RSV contributes to asthma development are not understood. The INSPIRE (Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure) study objectives are to: 1) characterize the host phenotypic response to RSV infection in infancy and the risk of recurrent wheeze and asthma, 2) identify the immune response and lung injury patterns of RSV infection that are associated with the development of early childhood wheezing illness and asthma, and 3) determine the contribution of specific RSV strains to early childhood wheezing and asthma development. This article describes the INSPIRE study, including study aims, design, recruitment results, and enrolled population characteristics. Methods/design The cohort is a population based longitudinal birth cohort of term healthy infants enrolled during the first months of life over a two year period. Respiratory infection surveillance was conducted from November to March of the first year of life, through surveys administered every two weeks. In-person illness visits were conducted if infants met pre-specified criteria for a respiratory illness visit. Infants will be followed annually to ages 3-4 years for assessment of the primary endpoint: wheezing illness. Nasal, urine, stool and blood samples were collected at various time points throughout the study for measurements of host and viral factors that predict wheezing illness. Nested case-control studies will additionally be used to address other primary and secondary hypotheses. Discussion In the INSPIRE study, 1952 infants (48% female) were enrolled during the two enrollment years and follow-up will continue through 2016. The mean age of enrollment was 60 days. During winter viral season, more than 14,000 surveillance surveys were carried out resulting in 2,103 respiratory illness visits on 1189 infants. First year follow-up has been completed on over 95% percent of participants from the first year of enrollment. With ongoing follow-up for wheezing and childhood asthma outcomes, the INSPIRE study will advance our understanding of the complex causal relationship between RSV infection and early childhood wheezing and asthma.
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Affiliation(s)
- Emma K Larkin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Martin L Moore
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Larry J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - William D Dupont
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - James D Chappell
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Patricia A Minton
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - R Stokes Peebles
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Paul E Moore
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Robert S Valet
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Donald H Arnold
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | - Suman R Das
- Virology Department, J. Craig Venter Institute, Rockville, MD, USA.
| | - Fernando P Polack
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Tina V Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Porsbjerg C, Lange P, Ulrik CS. Lung function impairment increases with age of diagnosis in adult onset asthma. Respir Med 2015; 109:821-7. [PMID: 25962648 DOI: 10.1016/j.rmed.2015.04.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Asthma-onset in older individuals has been associated with an accelerated decline in lung function, but direct comparisons with younger adults have not been reported. METHODS In a random population sample comprising 4983 individuals from the Copenhagen City Heart Study without asthma at baseline, we compared young (<35 years), middle-aged (35-64 years) and older (>64 years) adults with newly diagnosed asthma during a 10-year follow-up. RESULTS The proportion of cases with newly diagnosed asthma during follow-up was similar across age groups (Older adults: 7% (84/1168), middle-aged adults: 7% (223/3147), and young adults: 6% (42/668) (p = ns)). In all three age groups, lung function was reduced at baseline in subjects who were subsequently diagnosed with asthma, but most pronounced in those >35 years. (Mean FEV1%: Young 90.2% (±13.9), middle-aged 80.8% (±20.8), and older adults 80.8% (±24.2), p < 0.001). Furthermore, incident asthma was associated with an accelerated decline in lung function in older adults (young adults 11.0 mL/year, middle-aged adults 18.2 mL/year, and older adults 30.8 mL/year). These differences were independent of FEV1 at baseline and smoking status, and were not explained by undiagnosed asthma in older adults, as the frequency of respiratory symptoms, including wheeze, was similar in all three age groups at baseline. CONCLUSIONS Asthma was diagnosed as frequently in older as in younger adults. Preexisting symptoms were equally common, but lung function was more reduced pre-diagnosis, and declined more rapidly in older adults. This emphasizes the need for a high level of therapeutic attention in patients with asthma diagnosed late in life.
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Affiliation(s)
- Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark.
| | - Peter Lange
- Department of Public Health, University of Copenhagen, Denmark; Department of Respiratory Medicine, Hvidovre Hospital, Denmark; The Copenhagen City Heart Study, Frederiksberg Hospital, Denmark.
| | - Charlotte Suppli Ulrik
- Institute of Clinical Medicine, University of Copenhagen, Denmark; Department of Respiratory Medicine, Hvidovre Hospital, Denmark.
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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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Harada T, Yamasaki A, Fukushima T, Hashimoto K, Takata M, Kodani M, Okazaki R, Takeda K, Watanabe M, Kurai J, Shimizu E. Causes of death in patients with asthma and asthma-chronic obstructive pulmonary disease overlap syndrome. Int J Chron Obstruct Pulmon Dis 2015; 10:595-602. [PMID: 25834418 PMCID: PMC4370684 DOI: 10.2147/copd.s77491] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The administration of inhaled corticosteroids and worldwide usage of several asthma guidelines have improved asthma mortality. Elderly patients with asthma show high mortality rates, and may have several comorbidities, including overlap with chronic obstructive pulmonary disease (COPD). Among patients showing asthma overlapped with COPD (asthma–COPD overlap syndrome; ACOS), mortality is worse than for asthma alone. Therefore, we investigated comorbidities, malignancies, and causes of death in patients with asthma and ACOS. Methods This was a retrospective study. From January 2000 to March 2012, 650 patients were followed up at Tottori University Hospital. Medical records were reviewed to collect data regarding patient characteristics and comorbidities, and causes of death were recorded for patients who died during the study period. Results Eighty-seven patients died during the study period. The most frequent cause of death was malignancy. The proportion of malignant disease was 21.7% in all patients, 19.4% in patients with asthma alone, and 32.4% in patients with ACOS. One patient died from an asthma attack during this period. Conclusion The most frequent cause of death in patients with asthma and ACOS was malignant disease. It is necessary to control not only asthma but also comorbidities in patients with asthma, especially in those with ACOS.
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Affiliation(s)
- Tomoya Harada
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Akira Yamasaki
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Takehito Fukushima
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Kiyoshi Hashimoto
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Miki Takata
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Masahiro Kodani
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Ryota Okazaki
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Kenichi Takeda
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Masanari Watanabe
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Jun Kurai
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Eiji Shimizu
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
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Porsbjerg C, Sverrild A, Stensen L, Backer V. The level of specialist assessment of adult asthma is influenced by patient age. Respir Med 2014; 108:1453-9. [PMID: 25087903 DOI: 10.1016/j.rmed.2014.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Late onset asthma is associated with more severe disease and higher morbidity than in younger asthma patients. This may in part relate to under recognition of asthma in older adults, but evidence on the impact of patient age on diagnostic assessment of asthma in a specialist setting is sparse. AIM To examine the impact of patient age on the type and proportion of diagnostic tests performed in patients undergoing specialist assessment for asthma. METHODS Data from a clinical population consisting of all patients consecutively referred over a 12 months period to a specialist clinic for assessment of asthma were analysed. RESULTS A total of 224 patients with asthma or suspected asthma were referred during the 12 month period; 86 adults aged <35 years, 95 aged 35-55 years and 43 aged >55 years. Symptom characteristics were similar, but adults >35 years had a lower lung function than younger adults, and were more frequently smokers. However, a regression analysis showed that older age was associated with a lower likelihood of diagnostic assessment with a reversibility test, a bronchial challenge test, or measurement of exhaled NO, independently of a known diagnosis of asthma, smoking habits and lung function at referral. CONCLUSION A lower level of diagnostic assessment was observed already after the age of 35 years, indicating a risk for under diagnosis of asthma at an earlier patient age than previously thought.
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Affiliation(s)
- C Porsbjerg
- Respiratosry Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - A Sverrild
- Respiratosry Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - L Stensen
- Respiratosry Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - V Backer
- Respiratosry Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Makra L, Matyasovszky I, Bálint B, Csépe Z. Association of allergic rhinitis or asthma with pollen and chemical pollutants in Szeged, Hungary, 1999-2007. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:753-68. [PMID: 23558448 DOI: 10.1007/s00484-013-0656-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 05/23/2023]
Abstract
The effect of biological (pollen) and chemical air pollutants on respiratory hospital admissions for the Szeged region in Southern Hungary is analysed. A 9-year (1999-2007) database includes--besides daily number of respiratory hospital admissions--daily mean concentrations of CO, PM10, NO, NO2, O3 and SO2. Two pollen variables (Ambrosia and total pollen excluding Ambrosia) are also included. The analysis was performed for patients with chronic respiratory complaints (allergic rhinitis or asthma bronchiale) for two age categories (adults and the elderly) of males and females. Factor analysis was performed to clarify the relative importance of the pollutant variables affecting respiratory complaints. Using selected low and high quantiles corresponding to probability distributions of respiratory hospital admissions, averages of two data sets of each air pollutant variable were evaluated. Elements of these data sets were chosen according to whether actual daily patient numbers were below or above their quantile value. A nonparametric regression technique was applied to discriminate between extreme and non-extreme numbers of respiratory admissions using pollen and chemical pollutants as explanatory variables. The strongest correlations between extreme patient numbers and pollutants can be observed during the pollen season of Ambrosia, while the pollen-free period exhibits the weakest relationships. The elderly group with asthma bronchiale is characterised by lower correlations between extreme patient numbers and pollutants compared to adults and allergic rhinitis, respectively. The ratio of the number of correct decisions on the exceedance of a quantile resulted in similar conclusions as those obtained by using multiple correlations.
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Affiliation(s)
- László Makra
- Department of Climatology and Landscape Ecology, University of Szeged, POB 653, 6701, Szeged, Hungary,
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Milanese M, Di Marco F, Corsico AG, Rolla G, Sposato B, Chieco-Bianchi F, Costantino MT, Crivellaro MA, Guarnieri G, Scichilone N. Asthma control in elderly asthmatics. An Italian observational study. Respir Med 2014; 108:1091-9. [PMID: 24958604 DOI: 10.1016/j.rmed.2014.05.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exponential increase of individuals aged >64 yrs is expected to impact the burden of asthma. We aimed to explore the level of asthma control in elderly subjects, and factors influencing it. METHODS A multicenter observational study was performed on consecutive patients >64 years old with a documented physician-diagnosis of asthma. Sixteen Italian centers were involved in this 6-month project. FINDINGS A total of 350 patients were enrolled in the study. More than one-third of elderly asthmatic patients, despite receiving GINA step 3-4 antiasthmatic therapy, had an Asthma Control Test score ≤19, with a quarter experiencing at least one severe asthma exacerbation in the previous year. Twenty-nine percent of patients (n = 101) were classified as having Asthma-COPD Overlap Syndrome (ACOS) due to the presence of chronic bronchitis and/or CO lung diffusion impairment. This subgroup of patients had lower mean Asthma Control Test scores and more exacerbations compared to the asthmatic patients (18 ± 4 compared to 20 ± 4, p < 0.01, and 43% compared to 18%, p < 0.01, respectively). Modified Medical Research Council dyspnea mMRC scores and airway obstruction, assessed on the basis of a FEV(1)/FVC ratio below the lower limit of normal, were more severe in ACOS than in asthma, without any difference in responses to salbutamol. In a multivariate analysis, the mMRC dyspnea score, FEV(1)% of predicted and the coexistence of COPD were the only variables to enter the model. INTERPRETATION Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control.
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Affiliation(s)
- M Milanese
- Struttura Complessa di Pneumologia, Azienda Sanitaria Locale 2 Savonese, Pietra Ligure, Italy.
| | - F Di Marco
- Struttura Complessa di Pneumologia Ospedale S. Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - A G Corsico
- Struttura Complessa di Pneumologia, Fondazione IRCCS Policlinico San Matteo, Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | - G Rolla
- Allergologia e Immunologia Clinica Università di Torino, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - B Sposato
- Pneumologia, Azienda Ospedale Misericordia, Grosseto, Italy
| | - F Chieco-Bianchi
- Struttura Complessa di Fisiopatologia Respiratoria, Azienda Ospedaliera di Padova, Padova, Italy
| | - M T Costantino
- Struttura Complessa di Pneumologia, Azienda Ospedaliera Carlo Poma di Mantova, Mantova, Italy
| | - M A Crivellaro
- Servizio di Allergologia, Medicina del Lavoro, Azienda Ospedaliera Università degli Studi di Padova, Padova, Italy
| | - G Guarnieri
- Fisiopatologia Respiratoria, Medicina del Lavoro, Università di Padova, Padova, Italy
| | - N Scichilone
- DIBIMIS, Università degli Studi di Palermo, Palermo, Italy
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Yáñez A, Cho SH, Soriano JB, Rosenwasser LJ, Rodrigo GJ, Rabe KF, Peters S, Niimi A, Ledford DK, Katial R, Fabbri LM, Celedón JC, Canonica GW, Busse P, Boulet LP, Baena-Cagnani CE, Hamid Q, Bachert C, Pawankar R, Holgate ST. Asthma in the elderly: what we know and what we have yet to know. World Allergy Organ J 2014; 7:8. [PMID: 25152804 PMCID: PMC4137434 DOI: 10.1186/1939-4551-7-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/02/2014] [Indexed: 02/07/2023] Open
Abstract
In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.
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Affiliation(s)
- Anahí Yáñez
- Investigaciones en Alergia y Enfermedades Respiratorias- InAER, Buenos Aires, Argentina
| | - Sang-Hoen Cho
- Department of Internal Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Joan B Soriano
- Programa de Epidemiologia e Investigacion Clinica, Fundación Caubet-CIMERA, Illes Balears, Spain
| | - Lanny J Rosenwasser
- Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missoui, United States of America
| | - Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Klaus F Rabe
- Krankenhaus Lungen Clinic, Grosshansdorf, Germany
| | - Stephen Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Akio Niimi
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kyoto, Japan
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Medicine, Morsani University of South Florida College of Medicine, James A Haley Veterans Hospital, Tampa, Florida, United States of America
| | - Rohit Katial
- Division of Allergy and Immunology, National Jewish Health, Denver, Colorado, United States of America
| | - Leonardo M Fabbri
- Department of Oncology, Haematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania, United States of America
| | | | - Paula Busse
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Louis-Phillippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, (Quebec Heart and Lung Institute, Laval University), Quebéc, Canada
| | - Carlos E Baena-Cagnani
- Centre for Research in Respiratory Medicine, Catholic University of Córdoba, Córdoba, Argentina
| | - Qutayba Hamid
- Meakins-Christie Laboratories, McGill University, Quebéc, Canada
| | - Claus Bachert
- Upper Airways Research Laboratory (URL), Clinics ENT-Department, University Hospital Ghent, Ghent, Belgium
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Stephen T Holgate
- Faculty of Medicine Clinical and Experimental Sciences, University of Southampton, Hampshire, United Kingdom
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45
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Wu ST, Juhn YJ, Sohn S, Liu H. Patient-level temporal aggregation for text-based asthma status ascertainment. J Am Med Inform Assoc 2014; 21:876-84. [PMID: 24833775 DOI: 10.1136/amiajnl-2013-002463] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To specify the problem of patient-level temporal aggregation from clinical text and introduce several probabilistic methods for addressing that problem. The patient-level perspective differs from the prevailing natural language processing (NLP) practice of evaluating at the term, event, sentence, document, or visit level. METHODS We utilized an existing pediatric asthma cohort with manual annotations. After generating a basic feature set via standard clinical NLP methods, we introduce six methods of aggregating time-distributed features from the document level to the patient level. These aggregation methods are used to classify patients according to their asthma status in two hypothetical settings: retrospective epidemiology and clinical decision support. RESULTS In both settings, solid patient classification performance was obtained with machine learning algorithms on a number of evidence aggregation methods, with Sum aggregation obtaining the highest F1 score of 85.71% on the retrospective epidemiological setting, and a probability density function-based method obtaining the highest F1 score of 74.63% on the clinical decision support setting. Multiple techniques also estimated the diagnosis date (index date) of asthma with promising accuracy. DISCUSSION The clinical decision support setting is a more difficult problem. We rule out some aggregation methods rather than determining the best overall aggregation method, since our preliminary data set represented a practical setting in which manually annotated data were limited. CONCLUSION Results contrasted the strengths of several aggregation algorithms in different settings. Multiple approaches exhibited good patient classification performance, and also predicted the timing of estimates with reasonable accuracy.
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Affiliation(s)
- Stephen T Wu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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46
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Federman AD, Wolf MS, Sofianou A, Martynenko M, O’Connor R, Halm EA, Leventhal H, Wisnivesky JP. Self-management behaviors in older adults with asthma: associations with health literacy. J Am Geriatr Soc 2014; 62:872-9. [PMID: 24779482 PMCID: PMC4024064 DOI: 10.1111/jgs.12797] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine self-management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy. DESIGN Observational cohort study. SETTING Primary care and pulmonary specialty practices in two tertiary academic medical centers and three federally qualified health centers in New York, New York, and Chicago, Illinois. PARTICIPANTS Adults with moderate or severe persistent asthma aged 60 and older (N = 433). MEASUREMENTS Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. RESULTS The mean age was 67, and 36% of participants had marginal or low health literacy. Adherence was low (38%) overall and worse in individuals with low health literacy (22%) than in those with adequate literacy (47%, P < .001) and after adjusting for demographic factors and health status (odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.31-0.73). Similarly, inhaler technique was poor; only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse in those with low health literacy (MDI technique: OR = 0.57, 95% CI = 0.38-0.85; DPI technique: OR = 0.42, 95% CI = 0.25-0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. CONCLUSION Adherence to medications and inhaler technique are poor in older adults with asthma and worse in those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique and use low-literacy communication strategies to support self-management in older adults with asthma.
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Affiliation(s)
- Alex D. Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Michael S. Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
| | - Anastasia Sofianou
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Melissa Martynenko
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
| | - Rachel O’Connor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
| | - Ethan A. Halm
- Division of General Internal Medicine, University of Texas Southwestern Medical Center
| | - Howard Leventhal
- Institute of Health, Health Care Policy and Aging Research, Rutgers University
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine
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47
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Scichilone N, Pedone C, Battaglia S, Sorino C, Bellia V. Diagnosis and management of asthma in the elderly. Eur J Intern Med 2014; 25:336-42. [PMID: 24445022 DOI: 10.1016/j.ejim.2014.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 12/16/2022]
Abstract
Bronchial asthma is one of the most common chronic diseases worldwide, and by definition not expected to recover with aging. However, the concept that asthma can affect older individuals has been largely denied in the past. In clinical practice, asthma that occurs in the most advanced ages is often diagnosed as COPD, thus leading to undertreatment or improper treatment. The heterogeneity of clinical and functional presentation of geriatric asthma, including the partial loss of reversibility and of the allergic component, contributes to this misconception. A large body of evidence has accumulated demonstrating that the prevalence of asthma in the most advanced ages is similar to that in younger ages. The frequent coexistence of comorbid conditions in older patients compared to younger asthmatics, together with age-associated changes of the human lung, may render the management of asthma a complicated task. The article addresses the main issues related to the diagnosis and treatment of asthma in the geriatric age.
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Affiliation(s)
- Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy.
| | - Claudio Pedone
- Area of Geriatrics, Campus Biomedico University and Teaching Hospital, Rome, Italy
| | - Salvatore Battaglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Claudio Sorino
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy; U.O. di Pneumologia, Ospedale Sant'Anna, Como, Italy
| | - Vincenzo Bellia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy
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48
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Dhillon RK, Yawn BP, Yoo KH, Boyce TG, Jacobson RM, McGree ME, Weaver AL, Juhn YJ. Impact of Asthma on the Severity of Serious Pneumococcal Disease. ACTA ACUST UNITED AC 2014; Suppl 3. [PMID: 25243098 PMCID: PMC4166487 DOI: 10.4172/2161-1165.s3-001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We recently reported an increased risk of serious pneumococcal disease (SPD) in asthmatics. Little is known about the impact of asthma status on the severity of SPD. We compared the severity of serious pneumococcal disease (SPD) between patients with asthma and those without asthma. The study subjects were Rochester, Minnesota residents who developed SPD between 1964 and 1983. SPD and asthma status were ascertained by using explicit predetermined criteria Severity of SPD was assessed using intensive care unit (ICU) admission rate and total days of ICU stay and hospitalization associated with treatment for SPD. We found that there were no significant differences in severity outcomes between asthmatics (n=11) and non-asthmatics (n=163). Asthma status may increase the risk of SPD but not influence its severity. However, given a small sample size of our study, a larger study needs to be considered to clarify the relationship between asthma and severity of SPD.
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Affiliation(s)
- Ravneet K Dhillon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN
| | - Kwang Ha Yoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN ; Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Thomas G Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | | | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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49
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Iwanaga T, Tohda Y. [Bronchial asthma: progress in diagnosis and treatments. Topics: I. Basic knowledge; 3. Asthma in the elderly]. ACTA ACUST UNITED AC 2013; 102:1343-51. [PMID: 23947198 DOI: 10.2169/naika.102.1343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine, Japan
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50
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Bang DW, Yang HJ, Ryoo E, Al-Hasan MN, Lahr B, Baddour LM, Yawn BP, Juhn YJ. Asthma and risk of non-respiratory tract infection: a population-based case-control study. BMJ Open 2013; 3:e003857. [PMID: 24091424 PMCID: PMC3796274 DOI: 10.1136/bmjopen-2013-003857] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Asthmatics have increased risks of airway-related infections. Little is known about whether this is true for non-airway-related serious infections such as Escherichia coli bloodstream infection (BSI). We assessed whether asthma is associated with a risk of developing community-acquired E coli BSI. DESIGN The study was designed as a population-based retrospective case-control study. SETTING This population-based study was conducted in Olmsted County, Minnesota. PARTICIPANTS The study included 259 all eligible community-acquired E coli BSI cases in Olmsted County, MN between 1998 and 2007 and 259 birthday-matched, gender-matched and residency-matched controls. PRIMARY AND SECONDARY OUTCOME MEASURES Only community-acquired E coli BSI cases as the primary outcome was included. Asthma status as an exposure was ascertained by predetermined criteria. An adjusted OR and 95% CI for the association between asthma and risk of community-acquired E coli BSI was calculated using conditional logistic regression. RESULTS Of 259 eligible cases, 179 (69%) were women and mean age was 61±22 years. Of the 259 cases 37 (14%) and 16 (6%) of 259 controls had a prior history of asthma (adjusted OR 2.74; 95% CI 1.11 to 6.76; p=0.029). The population attributable risk of asthma for community-acquired E coli BSI was 9%. Although not statistically significant, there was a borderline association between having a history of food allergy and increased risk of community-acquired E coli BSI (6% vs 2%; adjusted OR 3.51; 95% CI 0.94 to 13.11; p=0.062). CONCLUSIONS Based on the findings of the current population-based, case-control investigation, a history of asthma may be associated with risk of community-acquired E coli BSI. The impact of asthma on risk of microbial infections may go beyond airways.
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Affiliation(s)
- Duk Won Bang
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Hyeon J Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, South Korea
| | - Eell Ryoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Gil Hospital, Gachon University School of Medicine, Inchon, South Korea
| | - Majdi N Al-Hasan
- Department of Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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