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Trinh HKT, Ban GY, Lee JH, Park HS. Leukotriene Receptor Antagonists for the Treatment of Asthma in Elderly Patients. Drugs Aging 2017; 33:699-710. [PMID: 27709465 DOI: 10.1007/s40266-016-0401-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD. There are a variety of co-morbidities with EA, of which COPD, upper airway diseases, depression, obesity, and hypertension are the most common, and these co-morbidities can affect the control status of EA. However, leukotriene receptor antagonists (LTRAs) can facilitate the management of EA, and thus addition of an LTRA to inhaled corticosteroid (ICS) monotherapy or ICS plus long-acting β2-agonist therapy improves symptoms in EA patients. LTRA treatment is safe and beneficial in patients who are unable to use inhalation devices properly or who have co-morbid diseases. Therefore, clinical studies targeting a specific population of EA patients are warranted to help achieve a better therapeutic strategy in EA patients.
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Affiliation(s)
- Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ji-Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea. .,Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, South Korea.
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Abstract
PURPOSE OF REVIEW We are in the era of rapid aging of the global population. Elderly asthmatic patients have an increased frequency of hospitalization and a high mortality rate. In this review, we focus on comorbidities and treatment issues in terms of the predictors of asthma control in the elderly. RECENT FINDINGS Some frequent comorbidities, such as chronic obstructive pulmonary disease, chronic sinusitis, obesity, and depression, are associated with uncontrolled asthma in elderly asthmatic patients. Smoking status in elderly asthmatic patients was associated with more frequent exacerbations. Management of comorbidities should be taken into account when we treat elderly asthmatic patients. Low treatment adherence, which is common in elderly asthmatic patients, predicts poor asthma control status. A poor knowledge about asthma, cognitive function impairment, and inappropriate inhaler technique result in low treatment adherence. Polypharmacy is associated with low treatment adherence, adverse drug reactions, and drug-drug interactions, and it is supposed to be a predictor of asthma control. SUMMARY Multifactorial assessments, including comorbidities, treatment adherence, and polypharmacy, are important for better asthma control in elderly asthmatic patients. Further studies on the strategy for the management of elderly asthmatic patients in a real-world setting are warranted.
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53
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Asthma Morbidity, Comorbidities, and Modifiable Factors Among Older Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:236-243.e7. [PMID: 28756082 DOI: 10.1016/j.jaip.2017.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Asthma morbidity is increased among older adults, especially older adult women. Interventions to improve asthma control in this population are not well described. OBJECTIVE The objective of this study was to identify risk factors (including modifiable factors) associated with asthma-related hospitalizations and emergency department or urgent care center visits (ED/UCV) among older adults. A secondary objective was to investigate sex differences in variables relevant to asthma control. METHODS Data were obtained from 14,076 older adults ≥65 years with active asthma participating in the 2006-2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey (a random-digit dialed survey) in 40 US states, the District of Columbia, and Puerto Rico, representative of >2.6 million persons. Weighted, adjusted logistic regression was conducted. RESULTS One or more asthma-related hospitalizations in the past year were reported by 5.7% (95% confidence interval [95% CI] = 5.0% to 6.4%) of participants; 10.6% (95% CI = 9.7% to 11.5%) reported ≥1 asthma-related ED/UCV. Compared with older adults without asthma-related hospitalizations, adjusted odds were higher among those with ≥1 asthma-related hospitalization for chronic obstructive pulmonary disease (COPD), coronary artery disease, depression, cockroaches or mold in the home, and cost barriers to asthma-related health care or medication. All these factors, except for cockroaches, were associated with asthma-related ED/UCV. Compared with males, adjusted odds were higher among females for COPD, depression, obesity, and cost barriers to asthma-related health care or medication. CONCLUSIONS Among older adults, asthma-related hospitalizations and ED/UCV were associated with clinical comorbidities, mold in the home, and financial barriers to asthma-related health care. Interventions addressing modifiable factors could reduce asthma morbidity among older adults.
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Iwanaga T, Sano H, Tohda Y. The current state and provisions for elderly patients with asthma. J Gen Fam Med 2017; 18:102-107. [PMID: 29264003 PMCID: PMC5689401 DOI: 10.1002/jgf2.6] [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] [Received: 05/21/2015] [Accepted: 09/24/2015] [Indexed: 01/12/2023] Open
Abstract
Demographic statistics of Japan indicate that it is moving toward a super‐aging society and, accordingly, the ratio of elderly patients with asthma is also increasing. An important point in diagnosing elderly patients with asthma is that the onset of asthma in old age, along with a history of smoking, differentiation, and complications of chronic obstructive pulmonary disease must be considered. Primary care physicians must understand the characteristics of elderly patients when treating them. When conducting inhalation therapy in any asthmatic patient, especially elderly asthmatic patients, it is important to teach the patients proper technique and sustain medication adherence. We believe this effort will lead to an improvement in controlling asthma as well as a decrease in the number of asthma deaths.
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Affiliation(s)
- Takashi Iwanaga
- Department of Respiratory Medicine and Allergology Kindai University Faculty of Medicine Osakasayama Osaka Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology Kindai University Faculty of Medicine Osakasayama Osaka Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology Kindai University Faculty of Medicine Osakasayama Osaka Japan
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55
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De Martinis M, Sirufo MM, Ginaldi L. Allergy and Aging: An Old/New Emerging Health Issue. Aging Dis 2017; 8:162-175. [PMID: 28400983 PMCID: PMC5362176 DOI: 10.14336/ad.2016.0831] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/31/2016] [Indexed: 12/15/2022] Open
Abstract
Allergy reactions are the most common immunological diseases and represent one of the most widespread and fast growing chronic human health problems among people over 15 years of age in developed countries. As populations get older worldwide, allergy manifestations in aged persons will occur more often in the future. To date, there has been much more studies on allergies in children than in adults. As the population ages, clinicians must be prepared to meet all the elderly's health care needs, including these new and emerging health issue. Allergic diseases represent an old/new emerging health issue. Because many common illnesses masquerade as atopic disease, the differential diagnosis of suspected allergic diseases becomes more expanded in an aging population. Research in the field needs to focus on both human and animal model systems to investigate the impact of the aging process on the immunologic pathways underpinning allergy and its different facets.
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Affiliation(s)
- Massimo De Martinis
- Department of Life, Health, & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Maddalena Sirufo
- Department of Life, Health, & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lia Ginaldi
- Department of Life, Health, & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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56
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Guilleminault L, Ouksel H, Belleguic C, Le Guen Y, Germaud P, Desfleurs E, Leroyer C, Magnan A. Personalised medicine in asthma: from curative to preventive medicine. Eur Respir Rev 2017; 26:26/143/160010. [PMID: 28049124 DOI: 10.1183/16000617.0010-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/15/2016] [Indexed: 12/20/2022] Open
Abstract
The concept of asthma has changed substantially in recent years. Asthma is now recognised as a heterogeneous entity that is complex to treat. The subdivision of asthma, provided by "cluster" analyses, has revealed various groups of asthma patients who share phenotypic features. These phenotypes underlie the need for personalised asthma therapy because, in contrast to the previous approach, treatment must be tailored to the individual patient. Determination of the patient's asthma phenotype is therefore essential but sometimes challenging, particularly in elderly patients with a multitude of comorbidities and a complex exposure history. This review first describes the various asthma phenotypes, some of which were defined empirically and others through cluster analysis, and then discusses personalisation of the patient's diagnosis and therapy, addressing in particular biological therapies and patient education. This personalised approach to curative medicine should make way in the coming years for personalised preventive and predictive medicine, focused on subjects at risk who are not yet ill, with the aim of preventing asthma before it occurs. The concept of personalised preventive medicine may seem a long way off, but is it really?
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Affiliation(s)
- Laurent Guilleminault
- Dept of Pulmonary Medicine, Reunion Island University Hospital/South Reunion Island Hospital Group, Saint-Pierre, France .,INSERM, UMR 1188 Diabetes-Atherothrombosis Therapies Reunion Island Indian Ocean (DéTROI), Reunion Island Indian Ocean Cyclotron (CYROI) Platform, Sainte-Clotilde, France.,University of Reunion Island, UMR 1188, Sainte-Clotilde, France
| | - Hakima Ouksel
- Dept of Pulmonary Medicine, Angers University Hospital, Angers, France
| | - Chantal Belleguic
- Dept of Pulmonary Medicine, Rennes University Hospital, Rennes, France
| | - Yannick Le Guen
- Dept of Pulmonary Medicine, Rennes University Hospital, Rennes, France.,Pulmonary Medicine Practice, St Grégoire Private Hospital, Saint-Grégoire, France
| | - Patrick Germaud
- Nantes University Hospital, Nantes-Roscoff National Cystic Fibrosis Reference Centre, Nantes, France
| | | | - Christophe Leroyer
- European University of Brittany, University of Brest, EA3878, IFR148, Dept of Internal and Respiratory Medicine, La Cavale Blanche Hospital, Brest, France
| | - Antoine Magnan
- Nantes University Hospital, Nantes-Roscoff National Cystic Fibrosis Reference Centre, Nantes, France.,UMR_S 1087 CNRS UMR_6291, L'Institut du Thorax, University of Nantes, Nantes, France
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57
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Lee SH, Song WJ, Park HW, Kim SH, Park HK, Kim SH, Kwon YE, Kim TB, Lee BJ, Jee YK, Choi BW, Cho SH, Kim SS. Serum micronutrients levels and clinical features of elderly asthmatics. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.4.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- So-Hee Lee
- Departement of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Woo-Jung Song
- Departement of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Heung-Woo Park
- Departement of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Eun Kwon
- Department of Internal Medicine, Chosun University Medical School, Gwangju, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Byung-Jae Lee
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Choenan, Korea
| | - Byoung Whui Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Departement of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Sin Kim
- Departement of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
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58
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Ban GY, Ye YM, Kim SH, Hur GY, Kim JH, Shim JJ, Cho K, Cho JY, Park HS. Plasma LTE4/PGF2α Ratio and Blood Eosinophil Count Are Increased in Elderly Asthmatics With Previous Asthma Exacerbation. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:378-382. [PMID: 28497926 PMCID: PMC5446954 DOI: 10.4168/aair.2017.9.4.378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 01/20/2023]
Abstract
The tools for asthma control assessment recommended by the current guideline are cognitive function- and effort-dependent, which is substantially impaired in the elderly. The aim of this study is to investigate objective assessment tools of asthma control status and previous asthma exacerbation (AE) in elderly subjects. Asthmatics aged >60 years who were treated with step 2 or 3 by the Global Initiative for Asthma (GINA) guideline were enrolled. During the 12-week study period, the subjects used either 400 µg of budesonide plus 10 mg of montelukast or 800 µg of inhaled budesonide. The occurrence of AE during the 4-week run-in and 12-week treatment period was monitored. After 12-week of treatment, sputum eosinophil count, peripheral eosinophil count, the plasma leukotriene E4 (LTE4), and prostaglandin F2α (PGF2α) metabolite levels were measured using the UHPLC/Q-ToF MS system. The study subjects were divided into group 1 (asthmatics who experienced AE during the study period) and group 2 (those who did not). A total of 101 patients aged 60-85 years were enrolled. Twenty-three patients (22.8%) had experienced AE. The plasma LTE4 level, LTE4/PGF2α ratio, and peripheral eosinophil count were significantly higher in group 1 than in group 2 (P=0.023, P=0.010, P=0.033, respectively). The plasma LTE4/PGF2α ratio and peripheral eosinophil count at week 12 were significantly associated with previous AE (odds ratio [OR]=1.748, P=0.013; OR=1.256, P=0.027). Receiver operating characteristic (ROC) curves to discriminate the subjects with previous AE, including these 2 parameters, showed that the area under the curve was 0.700 (P=0.004), with 73.9% sensitivity and 47.9% specificity. In conclusion, a combination of plasma LTE4/PGF2α ratio and peripheral eosinophil count can be an objective assessment tool which is significantly associated with asthma control status in elderly asthmatics.
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Affiliation(s)
- Ga Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Joo Hee Kim
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Jae Jung Shim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kumsun Cho
- Department of Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Joo Youn Cho
- Department of Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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59
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Chiba S, Tsuchiya K, Ogata T, Imase R, Yagi T, Mishima Y, Jinta T, Saito K, Taki R, Isogai S, Jinn Y, Kawasaki T, Natsume I, Miyashita Y, Takagiwa J, Ishiwata N, Chiaki T, Kishi M, Tsukada Y, Yamasaki M, Inase N. Treatment of Asthma in the Elderly: Questionnaire Survey in Japan. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ijcm.2017.84023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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60
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Song WJ, Sintobin I, Sohn KH, Kang MG, Park HK, Jo EJ, Lee SE, Yang MS, Kim SH, Park HK, Kwon YE, Kim TB, Kim SH, Park HW, Chang YS, Lee BJ, Jee YK, Choi BW, Bachert C, Cho SH. Staphylococcal enterotoxin IgE sensitization in late-onset severe eosinophilic asthma in the elderly. Clin Exp Allergy 2016; 46:411-21. [PMID: 26436720 DOI: 10.1111/cea.12652] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma in the elderly (aged ≥ 65 years old) is a significant concern with high morbidity, but the pathophysiology remains unclear particularly in late-onset asthma. Recent studies suggest staphylococcal enterotoxin IgE (SE-IgE) sensitization to be a risk factor for asthma in general populations; however, the associations have not been examined in late-onset elderly asthma. OBJECTIVE We aimed to examine the associations of SE-IgE sensitization with late-onset asthma in the elderly, using a database of elderly asthma cohort study. METHODS A total of 249 elderly patients with asthma and 98 controls were analysed. At baseline, patients were assessed for demographics, atopy, induced sputum profiles and comorbidities including chronic rhinosinusitis (CRS). Serum total IgE and SE-IgE levels were measured. Asthma severity was assessed on the basis of asthma outcomes during a 12-month follow-up period. RESULTS At baseline, serum SE-IgE concentrations were significantly higher in patients with asthma than in controls [median 0.16 (interquartile range 0.04-0.53) vs. 0.10 (0.01-0.19), P < 0.001]. Elderly asthma patients with high SE-IgE levels had specific characteristics of having more severe asthma, sputum eosinophilia and CRS, compared to those with lower SE-IgE levels. In multivariate logistic regression analyses, the associations between serum SE-IgE concentrations and severe asthma were significant, independently of covariables [SE-IgE-high (≥ 0.35 kU/L) vs. negative (< 0.10 kU/L) group: odds ratio 7.47, 95% confidence interval 1.86-30.03, P = 0.005]. Multiple correspondence analyses also showed that high serum SE-IgE level had close relationships with severe asthma, CRS and sputum eosinophilia together. CONCLUSIONS AND CLINICAL RELEVANCE This is the first report on the significant associations of SE-IgE sensitization with late-onset asthma in the elderly, particularly severe eosinophilic asthma with CRS comorbidity. Our findings indicate a potential implication of SE in the high morbidity burden of elderly asthma and suggest clues to the pathogenesis of severe late-onset eosinophilic asthma in the elderly.
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Affiliation(s)
- W-J Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - I Sintobin
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - K-H Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - M-G Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - H-K Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - E-J Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Korea
| | - S-E Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Korea
| | - M-S Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - S-H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - H-K Park
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Korea
| | - Y E Kwon
- Department of Internal Medicine, Chosun University Medical School, Gwangju, Korea
| | - T-B Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S-H Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - H-W Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y-S Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - B-J Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-K Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - B W Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - C Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - S-H Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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61
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Gupta S, Arora V, Sharma OP, Satyanarayana L, Gupta AK. Prevalence & pattern of respiratory diseases including Tuberculosis in elderly in Ghaziabad - Delhi - NCR. Indian J Tuberc 2016; 63:236-241. [PMID: 27998495 DOI: 10.1016/j.ijtb.2016.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/15/2016] [Indexed: 11/24/2022]
Abstract
Elderly population is continuously increasing all over the world including India. Old age is associated with significant prevalence of chronic illnesses. Population based study to find prevalence & pattern of respiratory diseases in elderly in India is difficult to find. Present study was done in an urban locality of Ghaziabad inhabited mainly by low socio - economic status population. Two part questionnaire was used as main tool. Through part one 1522 elderly were screened for respiratory disease. Respiratory disease was confirmed & diagnosed by part two of questionnaire, physical examination & necessary investigations. Prevalence of respiratory diseases was 18.8% in this study. Prevalence of respiratory diseases was almost double in elderly males as compared to females. COPD was most prevalent respiratory disease followed by Bronchial asthma.
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Affiliation(s)
- Sonisha Gupta
- Associate Professor, Department of Tuberculosis & Respiratory Diseases, Santosh Medical College & Hospital, Ghaziabad, India.
| | | | - O P Sharma
- Geriatric Society of India, K-49, 2nd Floor, Green Park Main, New Delhi, Delhi 110016, India
| | | | - Atul Kumar Gupta
- Department of Surgery, Santosh Medical College & Hospital, Ghaziabad, India
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62
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Benfante A, Basile M, Battaglia S, Spatafora M, Scichilone N. Use of ICS/LABA (extra-fine and non-extra-fine) in elderly asthmatics. Ther Clin Risk Manag 2016; 12:1553-1562. [PMID: 27789954 PMCID: PMC5072519 DOI: 10.2147/tcrm.s103709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Age represents an exclusion criterion in randomized clinical trials designed to test the efficacy and safety of inhaled drugs in asthma. As a consequence, data on efficacy and safety of inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) combinations in elderly asthmatics are scanty. Older age is associated with an increased proportion of comorbid conditions; in addition, all organ functions undergo a process of senescence, thus reducing their ability to metabolize the agents. Overall, these age-associated conditions may variably, and often unpredictably, affect the metabolism and excretion of respiratory drugs. However, pharmacological treatment of asthma does not follow specific recommendations in the elderly. In the elderly, the ICS/LABA combinations may carry an increased risk of local indesiderable effects, primarily due to the lack of coordination between activation of the device and inhalation, and systemic adverse events, mainly due to the greater amount of active drug that is available because of the age-associated changes in organ functions as well as drug-to-drug and drug-to-concomitant disease interactions. The extra-fine formulations of ICSs/LABAs, which allow for a more favorable drug deposition in the lungs at a reduced dose, may contribute to overcome this issue. This review revises the efficacy and safety of treatment with ICSs/LABAs, focusing on the main pharmacodynamic and pharmacokinetic properties of the drugs and highlighting the potential risks in the elderly asthmatic population.
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Affiliation(s)
- Alida Benfante
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Marco Basile
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Salvatore Battaglia
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Mario Spatafora
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
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63
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Busse PJ, Birmingham JM, Calatroni A, Manzi J, Goryachokovsky A, Fontela G, Federman AD, Wisnivesky JP. Effect of aging on sputum inflammation and asthma control. J Allergy Clin Immunol 2016; 139:1808-1818.e6. [PMID: 27725186 DOI: 10.1016/j.jaci.2016.09.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aged asthmatic patients experience increased morbidity and mortality. Knowledge of the aging effect on airway inflammation and asthma control is limited. OBJECTIVE We sought to compare airway inflammation and its relationship to asthma control in aged versus younger patients and determine whether differences are asthma specific or caused by "inflamm-aging." METHODS We performed a prospective study of aged (>60 years) and younger (21-40 years) inner-city patients with asthma. After a run-in period to control for inhaled corticosteroid use, induced sputum was collected. Age-matched nonasthmatic control subjects were included to measure age-related inflammatory changes. RESULTS Aged (mean age, 67.9 ± 5.1 years; n = 35) compared with younger (mean age, 30.8 ± 5.9 years; n = 37) asthmatic patients had significantly worse asthma control and lower FEV1. Aged asthmatic patients had higher sputum neutrophil (30.5 × 104/mL and 23.1%) and eosinophil (7.0 × 104/mL and 3.8%) numbers and percentages compared with younger patients (neutrophils, 13.0 × 104/mL [P < .01] and 6.9% [P < .01]; eosinophils, 2.0 × 104/mL [P < .01] and 1.2% [P < .01]). Aged asthmatic patients had higher sputum IL-6 (P < .01) and IL-8 (P = .01) levels. No significant inflammatory differences between aged and younger control subjects were observed. In aged asthmatic patients increased sputum IL-6 and macrophage inflammatory protein 3α/CCL20 levels were significantly associated with decreased asthma control and increased sputum neutrophil numbers and IL-1β, IL-6, and macrophage inflammatory protein 3α/CCL20 levels were associated with hospitalization. CONCLUSIONS The inflammatory patterns of aged versus younger asthmatic patients are associated with increased sputum neutrophil and eosinophil values and cytokine levels related to neutrophil recruitment. Differences in airway inflammation can contribute to diminished asthma control in the aged. Further understanding of asthma pathophysiology in aged patients is needed to improve management of this vulnerable population.
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Affiliation(s)
- Paula J Busse
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Janette M Birmingham
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Joseph Manzi
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna Goryachokovsky
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Giselle Fontela
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Varraso R, Camargo CA. Diet and asthma: need to account for asthma type and level of prevention. Expert Rev Respir Med 2016; 10:1147-1150. [PMID: 27701925 DOI: 10.1080/17476348.2016.1240033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Raphaëlle Varraso
- a INSERM U1168 , VIMA (Aging and chronic diseases. Epidemiological and public health approaches) , Villejuif , France.,b UVSQ, UMR-S 1168 , Université Versailles St-Quentin-en-Yvelines , France
| | - Carlos A Camargo
- c Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA.,d Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , MA , USA.,e Department of Epidemiology , Harvard TH Chan School of Public Health , Boston , MA , USA
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Hira D, Komase Y, Koshiyama S, Oguma T, Hiramatsu T, Shiraki A, Nishikawa M, Nakanishi M, Tsuji T, Matsumoto H, Ichimura K, Iwanaga T, Morikawa M, Yasuba H, Sugaya F, Arakawa Y, Kobayashi Y, Kato T, Futamura Y, Tsuji F, Terada T. Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals. Allergol Int 2016; 65:444-449. [PMID: 27155752 DOI: 10.1016/j.alit.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/24/2016] [Accepted: 04/03/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no systematic analysis to identify problems involved with instruction on inhalation therapy for elderly patients. We conducted a nationwide questionnaire survey for patients and medical professionals. METHODS A questionnaire survey was conducted of adult patients on inhaled drugs (ages 18-92 years, 820 individuals) and medical professionals (pharmacists or nurses) who provided instruction on inhalation therapy to these patients in 23 institutions in Japan to investigate the technique and the level of understanding (knowledge) of the inhalation therapy. Changes in the recognition of performance of inhalation technique and inhalation knowledge with increasing age were analyzed. RESULTS According to patients' subjective assessment, there was no deterioration in the performance of the inhalation technique or loss of the knowledge with increasing age. On the other hand, medical professionals' objective assessment revealed a significant loss of both inhalation technique and knowledge with increasing age. Not many elderly patients noticed their own problems themselves, revealing a great perception gap between elderly patients and medical professionals. Thus, there was concern that patients would unconsciously practice the inhalation procedure improperly. On the other hand, in comparison with non-elderly patients, elderly patients were less resistant to continuation of therapy, suggesting that they would be more likely to accept instruction on inhalation therapy. CONCLUSIONS Elderly patients are apt to assume that they "understand well", therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy.
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Melo-Neto JSD, Stroppa-Marques AEZ, Gomes FDC. Profile of Pneumopathic Elderly Persons Admitted to a Pulmonary Rehabilitation Center. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Pneumopathies are defined as a group of respiratory diseases. Physiotherapy centers are a conventional treatment option which can help prevent and treat various pulmonary conditions. Objective: To characterize elderly persons with pneumopathies admitted for pulmonary rehabilitation. Methods: 84 elderly persons were admitted for pulmonary rehabilitation. Patients diagnosed with pulmonary disease and aged ≥60 years were included in the study. The following variables were analyzed: gender, age, marital status, profession, medical diagnosis, main medical complaint, associated diseases, and cardiovascular risk factors. Results: The most common lung disease is chronic obstructive pulmonary disease (COPD) (26.2%). Women showed a greater association with asthma [odds ratio (OR)=5.875; p=0.010]. Dyspnea was the most prevalent main complaint among this population (50%). Among the main complaints, difficulty walking was more associated with men (OR=2.85; p=0.055). Strokes were the main disease most commonly associated with pneumopathies (12.1%). Women had a greater association with other diseases (OR=5.34, p=0.068), especially when two diseases were presented simultaneously with lung disease (OR=2.32, p=0.041). Among the risk factors, physical inactivity (OR=3.33), alcohol consumption (OR=0.046) and history of smoking (OR=3.00) were significantly associated with men, while depression (OR=5.67) was significantly associated with women. Women exhibited a 3.28 greater association between allergies and pneumopathies than men (p=0.013). The practice of physical activity was more associated with women (OR=3.89; p=0.03). Osteoporosis was more prevalent among elderly women with pulmonary disease (OR=10.75; p<0.0001), and was also significantly associated with a history of smoking (OR=4.31; p=0.009). Conclusion: The most frequent diagnosis, main complaint and associated disease were COPD, dyspnea and strokes, respectively. Elderly woman exhibited a greater association with the diagnosis of bronchial asthma, and more diseases associated with lung disease. Physical inactivity, difficulty walking, and a history of alcohol consumption and smoking are more associated with men, while depression, the presence of allergies, regular physical activity and osteoporosis are more associated with women. Thus, the results demonstrate that these individuals have specific characteristics.
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Sposato B, Scalese M, Latorre M, Scichilone N, Matucci A, Milanese M, Masieri S, Rolla G, Steinhilber G, Rosati Y, Vultaggio A, Folletti I, Baglioni S, Bargagli E, Di Tomassi M, Pio R, Pio A, Maccari U, Maggiorelli C, Migliorini MG, Vignale L, Pulerà N, Carpagnano GE, Foschino Barbaro MP, Perrella A, Paggiaro PL. Effects of omalizumab in severe asthmatics across ages: A real life Italian experience. Respir Med 2016; 119:141-149. [PMID: 27692136 DOI: 10.1016/j.rmed.2016.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting. METHODS 105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years. RESULTS Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (β = -1.070; p = 0.046) passing from each age class was observed. CONCLUSION Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.
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Affiliation(s)
- B Sposato
- Pneumologia, Ospedale Misericordia, Grosseto, Italy.
| | - M Scalese
- Istituto di Fisiologia Clinica, CNR, Pisa, Italy
| | - M Latorre
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
| | - N Scichilone
- DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Palermo, Italy
| | - A Matucci
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - M Milanese
- Pneumologia, Ospedale S.Corona, Pietra Ligure, Italy
| | - S Masieri
- Clinica Otorinolaringoiatrica, Policlinico Umberto I, Università di Roma "Sapienza", Italy
| | - G Rolla
- Allergologia e Immunologia Clinica, Ospedale Mauriziano Umberto I, Università di Torino, Italy
| | | | - Y Rosati
- Pneumologia, Ospedale di Macerata, Italy
| | - A Vultaggio
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - I Folletti
- Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionale ed Ambientale, Dipartimento di Medicina, Università di Perugia, Az. Ospedaliera Santa Maria, Terni, Italy
| | | | - E Bargagli
- Pneumologia, Ospedale Le Scotte, Università di Siena, Italy
| | - M Di Tomassi
- Pneumologia, Ospedale Misericordia, Grosseto, Italy
| | - R Pio
- Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy
| | - A Pio
- Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy
| | - U Maccari
- Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy
| | - C Maggiorelli
- Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy
| | | | - L Vignale
- Pneumologia, Ospedale di Fivizzano, Italy
| | - N Pulerà
- Pneumologia, Ospedale di Livorno, Italy
| | - G E Carpagnano
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy
| | - M P Foschino Barbaro
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy
| | - A Perrella
- Pneumologia, Ospedale Misericordia, Grosseto, Italy
| | - P L Paggiaro
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
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Wang L, Salinas YD, DeWan AT. Gene-based analysis identified the gene ZNF248 is associated with late-onset asthma in African Americans. Ann Allergy Asthma Immunol 2016; 117:50-55.e2. [PMID: 27238579 PMCID: PMC5085297 DOI: 10.1016/j.anai.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/28/2016] [Accepted: 05/10/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late-onset asthma (LOA) has distinct characteristics and its pathogenesis might rely on unique pathways. Although current studies are focused primarily on childhood asthma, more research is needed to show the mechanisms underlying LOA. OBJECTIVE To conduct genomewide association analysis and gene-based analysis to identify single-nucleotide polymorphisms and genes associated with LOA. METHODS The Women's Health Initiative (WHI) observational cohort and the Multi-Ethnic Study of Atherosclerosis (MESA) were used to identify subjects with LOA. The association between LOA and body mass index and smoking was evaluated. In the discovery stage of the genetic analysis, 1,218 African American subjects from WHI with genotype data (271 cases and 947 controls) were used for single-nucleotide polymorphism and gene-based association analyses. Significant or suggestive results were subsequently investigated in an independent African American population from MESA (38 cases and 806 controls). RESULTS In WHI, the relative odds for LOA in obese vs normal-weight subjects was 2.55 (95% confidence interval 1.74-3.76). Ever smokers also had greater odds for LOA compared with never smokers (odds ratio 1.59, 95% confidence interval 1.21-2.09). The same trends were observed in MESA. In WHI, 6 single-nucleotide polymorphisms were associated with LOA at a genomewide-suggestive significance level (P < 1.0 × 10(-5)). The gene ZNF248 was associated with LOA and reached genomewide significance (P = 4.0 × 10(-7)). In MESA, the association between ZNF248 and LOA was successfully replicated (P = .015). CONCLUSION Smoking and obesity are risk factors for LOA. ZNF248 confers increased susceptibility to LOA in African Americans.
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Affiliation(s)
- Leyao Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Yasmmyn D Salinas
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Andrew T DeWan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
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Sarlus H, Eyjolfsdottir H, Eriksdotter M, Oprica M, Schultzberg M. Influence of Allergy on Immunoglobulins and Amyloid-β in the Cerebrospinal Fluid of Patients with Alzheimer's Disease. J Alzheimers Dis 2016; 48:495-505. [PMID: 26402013 DOI: 10.3233/jad-143147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Peripheral inflammation has been suggested to influence the development of Alzheimer's disease (AD). Elevated levels of pro-inflammatory markers in the plasma of patients with AD indicate that a systemic pro-inflammatory status occurs concomitantly with inflammatory changes in the brain. OBJECTIVE To investigate whether allergy influences the levels of immunoglobulins (Ig) and of pro- and anti-inflammatory cytokines in the serum and cerebrospinal fluid (CSF) from patients with AD, mild cognitive impairment (MCI), and subjective cognitive impairment (SCI). METHODS IgA, IgG, and its subclasses, IgM, and cytokines were analyzed in CSF and serum from patients with SCI, MCI, and AD, with or without allergy. The relation between allergy and Mini-Mental State Examination (MMSE) scores, and between allergy and CSF biomarkers for AD (phosphorylated (p)-tau, total (t)-tau, amyloid-β 42 (Aβ₄₂), were analyzed. RESULTS In MCI, the CSF levels of IgG2 were lower in allergic patients, and in AD, the levels of IgA and the IgG1/total IgG ratio were lower in allergic patients, compared to patients without allergy. MCI subjects with allergy had higher serum IgM levels compared to those without allergy. CSF levels of Aβ₄₂ were lower and MMSE scores were higher in AD patients with allergy than in those without allergy. CONCLUSIONS The presence of allergy was associated with seemingly beneficial effects on AD as suggested by higher Aβ₄₂ levels in CSF, and higher MMSE scores. Higher IgM levels and lower other Ig classes suggest that allergy may influence senescence of the immune response.
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Affiliation(s)
- Heela Sarlus
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Section for Neurodegeneration, Novum, Huddinge, Sweden
| | - Helga Eyjolfsdottir
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Section for Clinical Geriatrics, Novum, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Section for Clinical Geriatrics, Novum, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mircea Oprica
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Section for Neurodegeneration, Novum, Huddinge, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Schultzberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Section for Neurodegeneration, Novum, Huddinge, Sweden
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Xu KY, Wisnivesky JP, Martynenko M, Mhango G, Busse PJ, Wolf MS, Holguin F, Federman AD. Assessing the association of obesity and asthma morbidity in older adults. Ann Allergy Asthma Immunol 2016; 117:33-7. [PMID: 27234936 DOI: 10.1016/j.anai.2016.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity is a robust predictor of poor asthma control in younger adults. Given the high prevalence of asthma and obesity in older Americans, weight reduction could benefit asthma management in this population. OBJECTIVE To assess the association between obesity and asthma outcomes among older adults. METHODS We recruited from urban primary care clinics a prospective cohort of nonsmoking individuals with asthma who were 60 years or older without a history of other respiratory diseases. At baseline, body mass index (BMI) measurements were classified as normal (BMI, 18-25), overweight (BMI, 25-30), or obese (BMI, >30). Measures of asthma morbidity (Asthma Control Questionnaire [ACQ], and Mini Asthma Quality of Life Questionnaire [Mini-AQLQ]) and asthma-related resource utilization (inpatient or outpatient) were taken at baseline and at 3- and 12-month interviews. We used generalized estimating equation models to assess associations between obesity and asthma outcomes after controlling for potential confounders. RESULTS Of the 437 older adults with asthma in the study, 17% had a normal BMI, 32% were overweight, and 51% were obese. Unadjusted analyses revealed that obesity was associated with lower ACQ scores (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09-1.31) and poorer Mini-AQLQ scores (OR, 1.21; 95% CI, 1.11-1.33). Adjusted analyses revealed no significant association between obesity and ACQ (OR, 1.05; 95% CI, 0.96-1.15) and Mini-AQLQ (OR, 1.08; 95% CI, 0.99-1.19). CONCLUSION Our study suggests that obesity is not independently associated with worse asthma outcomes in older adults, reflecting potential differences in the mechanisms that link obesity with asthma control in older vs younger populations.
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Affiliation(s)
- Kevin Y Xu
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York; Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Martynenko
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paula J Busse
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fernando Holguin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alex D Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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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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72
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Zuo L, Pannell BK, Liu Z. Characterization and redox mechanism of asthma in the elderly. Oncotarget 2016; 7:25010-21. [PMID: 26843624 PMCID: PMC5041886 DOI: 10.18632/oncotarget.7075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/17/2016] [Indexed: 12/15/2022] Open
Abstract
Asthma is a chronic disease characterized by reversible airflow limitation, coughing, bronchial constriction, and an inflammatory immune response. While asthma has frequently been categorized as emerging in childhood, evidence has begun to reveal that the elderly population is certainly susceptible to late-onset, or even long-standing asthma. Non-atopic asthma, most commonly found in elderly patients is associated with elevated levels of serum and sputum neutrophils and may be more detrimental than atopic asthma. The mortality of asthma is high in the elderly since these patients often possess more severe symptoms than younger populations. The redox mechanisms that mediate inflammatory reactions during asthma have not been thoroughly interpreted in the context of aging. Thus, we review the asthmatic symptoms related to reactive oxygen species (ROS) and reactive nitrogen species (RNS) in seniors. Moreover, immune status in the elderly is weakened in part by immunosenescence, which is broadly defined as the decline in functionality of the immune system that corresponds with increasing age. The effects of immunosenescence on the expression of biomarkers potentially utilized in the clinical diagnosis of asthma remain unclear. It has also been shown that existing asthma treatments are less effective in the elderly. Thus, it is necessary that clinicians approach the diagnosis and treatment of asthmatic senior patients using innovative methods. Asthma in the elderly demands more intentional diagnostic and therapeutic research since it is potentially one of the few causes of mortality and morbidity in the elderly that is largely reversible.
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Affiliation(s)
- Li Zuo
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
- The Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Benjamin K. Pannell
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Zewen Liu
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Anesthesiology, Affiliated Ezhou Central Hospital, Renmin Hospital of Wuhan University Medical School, Hubei, China
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Su X, Ren Y, Li M, Zhao X, Kong L, Kang J. Prevalence of Comorbidities in Asthma and Nonasthma Patients: A Meta-analysis. Medicine (Baltimore) 2016; 95:e3459. [PMID: 27258489 PMCID: PMC4900697 DOI: 10.1097/md.0000000000003459] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study compares the prevalence rates of comorbidities between asthma and nonasthma control patients reported in the literature.Literature was searched in several electronic databases. After the selection of studies by following précised eligibility criteria, meta-analyses of odds ratios were carried out with subgroup and sensitivity analyses.Eleven studies studying 117,548 asthma patients compared with 443,948 non-asthma controls were included in the meta-analysis. The prevalence of cardiovascular comorbidities (odds ratio (OR): [95% CI] 1.90 [1.70, 2.14]; P < 0.00001), cerebrovascular comorbidities (OR 1.44 [1.29, 1.60]; P < 0.00001), obesity (OR 1.51 [1.14, 2.01]; P < 0.00001), hypertension (OR 1.66 [1.47, 1.88]; P < 0.00001, diabetes (OR 1.25 [1.08, 1.44]; P < 0.00001), other metabolic and endocrine comorbidities (OR 1.60 [1.40, 1.83]; P < 0.00001), psychiatric and neurological comorbidities (OR 1.62 [1.44, 1.82]; P < 0.00001), gut and urinary comorbidities (OR 1.91 [1.47, 2.49]; P < 0.00001),), cancer (OR 1.17 [1.10, 1.25]; P < 0.00001), and respiratory comorbidities (OR 5.60 [4.22, 7.44]; P < 0.00001) were significantly higher in the asthma patients in comparison with nonasthma controls.Asthma is associated with significantly higher comorbidities including cardio-/cerebrovascular diseases, obesity, hypertension, diabetes, psychiatric and neurological comorbidities, gut and urinary conditions, cancer, and respiratory problems other than asthma. Respiratory comorbidities are found 5 times more prevalent in asthma than in non-asthma patients.
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Affiliation(s)
- Xinming Su
- From the Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
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Agusta F, Battaglia S, Benfante A, Spatafora M, Scichilone N. Challenges in the pharmacological treatment of geriatric asthma. Expert Rev Clin Pharmacol 2016; 9:917-26. [PMID: 26986042 DOI: 10.1586/17512433.2016.1167596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Asthma in older populations is characterized by frequent comorbid conditions, which increase the risk of side effects and of detrimental interactions between respiratory and non-respiratory drugs. These observations lead to the need to manage asthma in older populations by applying a multidimensional assessment and a multidisciplinary treatment; therefore, we favor the use of the 'geriatric' term to define asthma in the elderly. Geriatric asthma is a complex disease, which may not necessarily imply that it is also complicated, although the two conditions may often coexist. On this basis, the switch from an organ-driven management to the holistic approach may be the key factor to attain optimal control of the disease in this age range. The current review discusses the age-related factors affecting asthma treatment in the oldest individuals, such as the comorbid conditions, and age-related changes of metabolism and excretion that can impair the efficacy and safety of drugs.
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Affiliation(s)
- Fabio Agusta
- a Dipartimento di Biomedicina e Medicina Interna e Specialistica , University of Palermo , Palermo , Italy
| | - Salvatore Battaglia
- a Dipartimento di Biomedicina e Medicina Interna e Specialistica , University of Palermo , Palermo , Italy
| | - Alida Benfante
- a Dipartimento di Biomedicina e Medicina Interna e Specialistica , University of Palermo , Palermo , Italy
| | - Mario Spatafora
- a Dipartimento di Biomedicina e Medicina Interna e Specialistica , University of Palermo , Palermo , Italy
| | - Nicola Scichilone
- a Dipartimento di Biomedicina e Medicina Interna e Specialistica , University of Palermo , Palermo , Italy.,b Dipartimento della salute delle popolazioni, nutraceutica e biomarkers , Istituto Euro-Mediterraneo della Scienza e Tecnologia , Palermo , Italy
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75
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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
Asthma affects a significant proportion of elderly patients, but unfortunately, it is responsible for a high asthma-related morbidity and mortality in this population. This may be related not only to the development of a more severe asthma phenotype compared to younger patients, with more marked airway obstruction and a more neutrophilic type of airway inflammation, but also to the presence of many co-morbid conditions. Furthermore, in older patients, asthma is often under-diagnosed, undertreated and poorly managed. Unfortunately, elderly patients have usually been excluded of clinical trials on asthma and there is an urgent need to perform more research on the optimal management of asthma in this population.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, Chemin Sainte-Foy, Québec City, Québec G1V 4G5 Canada
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78
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Kim MY, Song WJ, Cho SH. Pharmacotherapy in the management of asthma in the elderly: a review of clinical studies. Asia Pac Allergy 2016; 6:3-15. [PMID: 26844215 PMCID: PMC4731478 DOI: 10.5415/apallergy.2016.6.1.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/12/2016] [Indexed: 12/29/2022] Open
Abstract
Asthma in the elderly is a disease with emerging concern. Despite some recent advances in our understanding of epidemiology and pathophysiology, there is a considerable lack of clinical evidence specific to elderly patients. Currently available high quality clinical evidence has been mostly obtained from younger adults, but rarely from elderly patients. Under-representation of elderly patients in previous randomized trials may have been due to being, old age, or having comorbidities. Thus, a question may be raised whether current clinical evidence could be well generalized into elderly patients. Further clinical trials should address clinical issues raised in elderly population. In this review, we aimed to overview the efficacy and safety of pharmacological management, and also to summarize the literature relevant to elderly asthma.
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Affiliation(s)
- Mi-Yeong Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
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79
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Lombardi C, Raffetti E, Caminati M, Liccardi G, Passalacqua G, Reccardini F, Ridolo E, Senna G, Steinhilber G, Milanese M. Phenotyping asthma in the elderly: allergic sensitization profile and upper airways comorbidity in patients older than 65 years. Ann Allergy Asthma Immunol 2016; 116:206-11. [PMID: 26782672 DOI: 10.1016/j.anai.2015.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data about allergic rhinitis in elderly patients with asthma are lacking. OBJECTIVE To investigate the presence of rhinitis and the role of sensitization of airborne allergens in elderly patients with asthma. METHODS This was a multicenter cross-sectional study involving subjects at least 65 years old with asthma. Demographic features, comorbidities, and the presence of allergic respiratory disease were retrieved through interview. Skin prick tests for common allergens were performed. Associations of demographic and clinical features were evaluated in relation to asthma control and forced expiratory volume in the first second less than 80% in the total population and in the subgroup with features resembling chronic obstructive pulmonary disease. RESULTS Of 368 elderly subjects with asthma, 101 had features resembling chronic obstructive pulmonary disease. Rhinitis was present in 59.0% of subjects (allergic rhinitis in 47.6%), with an age of onset significantly different from that of asthma (49 ± 18 vs 57 ± 18 years). At least 1 sensitization was observed in 52.4% of subjects, more frequently for house dust mite (HDM; 31.8%). The prevalence of poorly and partially controlled asthma was higher in patients sensitized to airborne allergens (odds ratio 1.64, 95% confidence interval 1.03-2.61), in particular to HDM (odds ratio 1.73, 95% confidence interval 1.05-2.85). CONCLUSION Approximately 60% of elderly subjects with asthma had rhinitis, mainly allergic and often untreated, whose onset preceded asthma symptoms by a mean of approximately 10 years. Nonallergic asthma was better controlled than allergic asthma. However, HDM sensitization was greater in subjects with asthma with features resembling chronic obstructive pulmonary disease (39% vs 28%). When restricting analysis to this group, the negative role of HDM in overall asthma control (forced expiratory volume in first second and Asthma Control Test) was significant.
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Affiliation(s)
- Carlo Lombardi
- Unità Dipartimentale di Allergologia-Immunologia Clinica & Malattie Apparato Respiratorio, Ente Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Elena Raffetti
- Unità di Igiene, Epidemiologia e Sanità Pubblica dell'Università degli Studi di Brescia, Brescia, Italy
| | - Marco Caminati
- Unità Operativa di Allergologia, Azienda Ospedaliero-Universitaria Integrata di Verona, Verona, Italy
| | - Gennaro Liccardi
- Azienda Ospedaliera Cardarelli, Divisione di Pneumologia ad Indirizzo Allergologico, Napoli, Italy
| | | | - Federico Reccardini
- Struttura Complessa di Pneumologia, Azienda Ospedaliero Universitaria S Maria della Misericordia di Udine, Udine, Italy
| | - Erminia Ridolo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Parma, Italy
| | - GianEnrico Senna
- Unità Operativa di Allergologia, Azienda Ospedaliero-Universitaria Integrata di Verona, Verona, Italy
| | - Gundi Steinhilber
- Pneumologia e Fisiopatologia Respiratoria, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - M Milanese
- Struttura Complessa di Pneumologia, ASL 2 Savonese, Pietra Ligure (SV), Italy
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80
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Ma YC, Lin CC, Yang SY, Chen HJ, Li TC, Lin JG. Time Trend Analysis of the Prevalence and Incidence of Diagnosed Asthma and Traditional Chinese Medicine Use among Adults in Taiwan from 2000 to 2011: A Population-Based Study. PLoS One 2015; 10:e0140318. [PMID: 26484761 PMCID: PMC4618865 DOI: 10.1371/journal.pone.0140318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/24/2015] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to determine the annual trends of traditional Chinese medicine (TCM) use for prevalent and incident asthmatic adults in Taiwan from 2000 to 2011. The annual prevalence and incidence of asthma in adults among subgroups of sociodemographic factors were also investigated. Methods A population-based study was conducted using a random sample with one million beneficiaries of all residents aged ≥18 years enrolled in the National Health Insurance program. Adults diagnosed with asthma were identified from the National Health Insurance Research Database. The annual prevalence and incidence of asthma in the adult population were estimated by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes to identify relevant cases from 2000 to 2011. Results The number of annual prevalent cases of diagnosed asthma increased from 56,885 in 2000 to 101,535 in 2011. The prevalence increased significantly on annual basis, whereas the incidence rate fluctuated over time. The prevalence of TCM use by adults with asthma decreased significantly (p<0.05), from 38.58% in 2000 to 29.26% in 2011. The number of annual incident cases of diagnosed asthma decreased from 3,896 in 2000 to 2,684 in 2011. TCM use rates in asthma incident adults decreased significantly (p<0.05), from 54.24% in 2000 to 38.19% in 2011. Conclusion The prevalence of TCM utilization is high among adults with asthma in Taiwan. However, our study demonstrated a substantial decrease in the annual prevalence of TCM use by prevalent and incident asthmatic adults in Taiwan from 2000 to 2011. In addition, the prevalence of TCM use was higher among incident cases, compared with those with prevalent cases.
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Affiliation(s)
- Yi-Chun Ma
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Tai-An Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Sing-Yu Yang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- * E-mail: (TCL); (JGL)
| | - Jaung-Geng Lin
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- * E-mail: (TCL); (JGL)
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81
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Ban GY, Ye YM, Lee Y, Kim JE, Nam YH, Lee SK, Kim JH, Jung KS, Kim SH, Park HS. Predictors of Asthma Control by Stepwise Treatment in Elderly Asthmatic Patients. J Korean Med Sci 2015; 30:1042-7. [PMID: 26240480 PMCID: PMC4520933 DOI: 10.3346/jkms.2015.30.8.1042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/15/2015] [Indexed: 11/22/2022] Open
Abstract
The geriatric population is increasing, and asthma severity increases with age. We determined the predictors of asthma control, exacerbation, and the factors that affect asthma-specific quality of life (A-QOL) in elderly asthmatic patients. This was a prospective, multicenter, real-life study for 6 months with stepwise pharmacologic treatment based on the Global Initiative for Asthma (GINA) guideline. A total of 296 asthmatic patients aged ≥ 60 yr were recruited from 5 university centers in Korea. The improved-asthma control group was defined as the group of patients who maintained well-controlled or improved disease and the not-improved asthma control group was defined as the remaining patients. Fewer number of medications for comorbidities (2.8 ± 3.3 in the improved vs. 4.5 ± 4.4 in the control) and higher physical functioning (PF) scale (89.8 ± 14.2 in the improved vs. 82.0 ± 16.4 in the control) were significant predictors in the improved-asthma control group (OR = 0.863, P = 0.004 and OR = 1.028, P = 0.018, respectively). An asthma control test (ACT) score of ≤ 19 at baseline was a significant predictor of asthma exacerbation (OR = 3.938, P = 0.048). Asthma duration (F = 5.656, P = 0.018), ACT score (F = 12.237, P = 0.001) at baseline, and the presence of asthma exacerbation (F = 5.565, P = 0.019) were significant determinants of changes in A-QOL. The number of medications for comorbidities and performance status determined by the PF scale may be important parameters for assessing asthma control in elderly asthmatic patients.
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Affiliation(s)
- Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yunhwan Lee
- Department of Preventive Medicine & Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Jeong-Eun Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University School of Medicine, Busan, Korea
| | - Soo-Keol Lee
- Department of Internal Medicine, Dong-A University School of Medicine, Busan, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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82
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Song WJ, Jee YK. More Effective Strategies are Needed for Elderly Asthmatics in Real-World Practice. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:419-20. [PMID: 26122501 PMCID: PMC4509653 DOI: 10.4168/aair.2015.7.5.419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/06/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Woo Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
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83
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Gonzalez-Garcia M, Caballero A, Jaramillo C, Maldonado D, Torres-Duque CA. Prevalence, risk factors and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study. J Asthma 2015; 52:823-30. [PMID: 25996179 DOI: 10.3109/02770903.2015.1010733] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are differences in the prevalence and risk factors of asthma around the world. The epidemiological situation of adults 40 years and older is not well established. Our aim was to determine the prevalence, underdiagnosis and risk factors of asthma and wheezing in adults in Colombia. METHODS A cross-sectional, population-based study including 5539 subjects from 40 to 93 years selected by a probabilistic sampling technique in five cities was conducted. MEASUREMENTS respiratory symptoms and risk factors questionnaire and spirometry. DEFINITIONS (a) Wheezing: Affirmative answer to the question "have you ever had two or more attacks of "wheezes" causing you to feel short of breath?" (b) Asthma: Wheezing definition and FEV1/FVC post-bronchodilator ≥ 70%. (c) Underdiagnosis: Asthma definition without a physician-diagnosis. Logistic regression was used for exploring risk factors. RESULTS Prevalence of asthma was 9.0% (95% CI: 8.3-9.8) and wheezing 11.9% (95% CI: 11.0-12.8). Asthma underdiagnosis was 69.9% and increased to 79.0% in subjects 64 years or older. The risk factors related to asthma and/or wheezing were: living in Bogota or Medellin, female gender, first degree relative with asthma, respiratory disease before 16 years of age, obesity, no education, indoor wood smoke exposure and occupational exposure to dust particles, gases or fumes. CONCLUSION We described the epidemiologic situation of asthma in adults 40 years and older in Colombia. In addition to some recognized risk factors, our data supports the association of indoor wood smoke and occupational exposures with asthma and wheezing. Underdiagnosis of asthma in adults was high, particularly in older subjects.
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84
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Ozturk AB, Ozyigit Pur L, Kostek O, Keskin H. Association between asthma self-management knowledge and asthma control in the elderly. Ann Allergy Asthma Immunol 2015; 114:480-4. [PMID: 25935432 DOI: 10.1016/j.anai.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/31/2015] [Accepted: 04/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Considerable evidence points to the importance of patient education in achieving better asthma control. However, little is known about the effect of older adults' asthma knowledge on asthma control. OBJECTIVE To identify the relation between asthma self-management knowledge and short-term asthma control in older adults. METHODS The study included 82 patients with asthma undergoing usual asthma care who were interviewed by the same trained allergist. At the same time, the authors conducted an asthma knowledge questionnaire, an Asthma Control Test, skin prick testing, spirometry, and evaluation of inhaler device technique. The Turkish version of the asthma knowledge questionnaire was administered to all participants in face-to-face interviews. The relation between asthma knowledge and asthma control was tested by regression analysis. RESULTS The education level was below the secondary level in 79% of patients; 59% of patients were obese; and 44% of patients had mild, 41% had moderate, and 5% had severe persistent asthma. The atopy rate was 21%. The most common sensitization was to Dermatophagoides pteronyssinus. Fifty-two percent of patients had uncontrolled asthma; 22 patients showed proper use of the inhaler device. Forty patients (48%) had limited asthma knowledge. The main source of asthma knowledge was from physicians for 81% of patients. There was no significant association between patients' asthma knowledge and asthma control level (P = .991). CONCLUSION Knowledge of asthma was very low in elderly patients and usual asthma care was largely insufficient. These findings suggest that asthma education programs should be developed for older adults based on their education level and clinical asthma characteristics.
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Affiliation(s)
- A B Ozturk
- Department of Allergy and Immunology, Koç University, School of Medicine, Istanbul, Turkey.
| | - L Ozyigit Pur
- Department of Allergy and Immunology, Koç University, School of Medicine, Istanbul, Turkey
| | - O Kostek
- Department of Internal Medicine, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - H Keskin
- Department of Internal Medicine, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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85
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Thannickal VJ, Murthy M, Balch WE, Chandel NS, Meiners S, Eickelberg O, Selman M, Pardo A, White ES, Levy BD, Busse PJ, Tuder RM, Antony VB, Sznajder JI, Budinger GRS. Blue journal conference. Aging and susceptibility to lung disease. Am J Respir Crit Care Med 2015; 191:261-9. [PMID: 25590812 DOI: 10.1164/rccm.201410-1876pp] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aging of the population in the United States and throughout the developed world has increased morbidity and mortality attributable to lung disease, while the morbidity and mortality from other prevalent diseases has declined or remained stable. Recognizing the importance of aging in the development of lung disease, the American Thoracic Society (ATS) highlighted this topic as a core theme for the 2014 annual meeting. The relationship between aging and lung disease was discussed in several oral symposiums and poster sessions at the annual ATS meeting. In this article, we used the input gathered at the conference to develop a broad framework and perspective to stimulate basic, clinical, and translational research to understand how the aging process contributes to the onset and/or progression of lung diseases. A consistent theme that emerged from the conference was the need to apply novel, systems-based approaches to integrate a growing body of genomic, epigenomic, transcriptomic, and proteomic data and elucidate the relationship between biologic hallmarks of aging, altered lung function, and increased susceptibility to lung diseases in the older population. The challenge remains to causally link the molecular and cellular changes of aging with age-related changes in lung physiology and disease susceptibility. The purpose of this review is to stimulate further research to identify new strategies to prevent or treat age-related lung disease.
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86
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Song WJ, Jee HM, Suh DI, Yang HJ, Yoon JS, Yu J, Kim SH, Ye YM, Kim TB, Shin SY, Li K, Kim CW. Progress and Prospect: A Bibliometric Analysis of Research Papers by Korean Allergists Over Recent Five Years (2009-2013). ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:507-12. [PMID: 26122510 PMCID: PMC4509664 DOI: 10.4168/aair.2015.7.5.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/28/2015] [Indexed: 12/25/2022]
Abstract
Since the establishment of the academic society in 1972, Korean allergists have made continuous efforts to elucidate pathogenic mechanisms and therapeutic advances for allergic diseases. The present study aimed to summarize recent progress and explore future prospects of research performance by Korean allergists. We performed a comprehensive bibliometric analysis for research papers published in the Science Citation Index (SCI) or SCI-expanded journals by Korean allergists between 2009 and 2013. Research performance was quantitatively analyzed for the numbers of papers by publication year, research type, and main topic. In addition, the performance was also examined for qualitative indices, such as impact factor and citation number. A total of 1,091 papers were identified. The number of publication increased continuously, with an annual increase rate of 12.3%. Clinical and basic studies were the most frequent types of research, and recently the number of epidemiological studies has increased. By research topic, asthma was the most commonly studied, accounting for 20.9% of the total number of publications. Notably, the amount of rhinitis/rhinosinusitis research has risen steeply in 2013. Qualitative analyses also indicated continuous progress; the median impact factor of published journals increased from 1.918 in 2009 to 2.746 in 2013, yielding an annual increase rate of 7.4%. In conclusion, the present analyses identified a continuous increase in the research performance of Korean allergists over a recent 5 year period (2009-2013), both quantitatively and qualitatively. A more significant contribution is expected in the forthcoming era.
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Affiliation(s)
- Woo Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jong Yang
- Department of Pediatrics, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jong Seo Yoon
- Department of Pediatrics, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Youp Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee Medical Center, Seoul, Korea
| | - Kapsok Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Cheol Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
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87
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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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88
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Boulet LP. Is asthma control really more difficult to achieve in the elderly patient? Int Arch Allergy Immunol 2014; 165:149-51. [PMID: 25471119 DOI: 10.1159/000368966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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89
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Yáñez A, Cho SH, Soriano JB, Rosenwasser LJ, Rodrigo GJ, Rabe KF, Peters S, Niimi A, Ledford DK, Katial R, Hoyte FC, Fabbri LM, Celedón JC, Canonica GW, Busse P, Boulet LP, Baena-Cagnani CE, Hamid Q, Bachert C, Pawankar R, Holgate ST. Erratum: asthma in the elderly: what we know and what we have yet to know. World Allergy Organ J 2014. [PMCID: PMC4061778 DOI: 10.1186/1939-4551-7-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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