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Cao X, Liao Y, Wu X, Yang Q, Zhao J, Gong C, Xiang L, Tang Y. Willingness to use acupuncture: Knowledge, attitudes, beliefs, and practices among allergic rhinitis patients. Medicine (Baltimore) 2023; 102:e35297. [PMID: 37773868 PMCID: PMC10545284 DOI: 10.1097/md.0000000000035297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023] Open
Abstract
This study aims to assess knowledge, attitudes, beliefs, and practices (KABP) among China mainland allergic rhinitis (AR) participants regarding their willingness to use acupuncture. Little is known about the understanding, attitudes, beliefs and practices of people with AR in China. A questionnaire was designed and administered to AR participants in mainland China to gather information about KABP regarding acupuncture use. A total of 324 valid questionnaires were collected from 30 provinces on the Chinese mainland. We recorded basic information and data about AR. The questionnaire designed according to KABP theory and with excellent reliability (Cronbach α coefficient: 0.725) and validity (KMO: 0.819). Knowledge: Fifty-five percent (179) of respondents reported knowing about acupuncture. The majority (172) knew that acupuncture was used for AR; 119 had received acupuncture for AR, and about 66% were aware of acupuncture. Attitudes and beliefs: Seventy percent of patients were willing to recommend acupuncture for AR to family and friends. Practice: Approximately 75% of respondents were willing to undergo acupuncture if they knew it was effective for AR. Approximately 25% of the respondents answered "Do it a few times and see how it works," "Do several treatments depending on how much they can afford," or "It is up to the doctor to decide". Correlation analysis: Those who identified with traditional Chinese medicine showed a robust willingness to recommend acupuncture for treating other diseases to family and friends (R = 0.718, P < .01) and a robust willingness to recommend acupuncture for AR to their families and friends (R = 0.564, P < .01). Acupuncture for AR has shown excellent awareness, recommendation and acceptance in mainland China. Efficacy, affordability, and trust in doctors were the 3 key factors that led respondents to choose acupuncture for their AR. Identification with traditional Chinese medicine culture significantly influenced attitudes, leading to AR recommendations and acceptance of acupuncture.
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Affiliation(s)
- Xueqiu Cao
- Minda Hospital of Hubei Minzu University, Hubei Province, P.R. China
| | - Yong Liao
- Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province, P.R. China
| | - Xiaohui Wu
- Xiamen Childrens Hospital, Hubei Province, P.R. China
| | - Qiang Yang
- Minda Hospital of Hubei Minzu University, Hubei Province, P.R. China
| | - Junhui Zhao
- Minda Hospital of Hubei Minzu University, Hubei Province, P.R. China
| | - Cheng Gong
- Minda Hospital of Hubei Minzu University, Hubei Province, P.R. China
| | - Lin Xiang
- Minda Hospital of Hubei Minzu University, Hubei Province, P.R. China
| | - Yao Tang
- Minda Hospital of Hubei Minzu University, Hubei Province, P.R. China
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Abstract
The lungs are continually subjected to noxious and inert substances, are immunologically active, and are in a constant state of damage and repair. This makes the pulmonary system particularly vulnerable to diseases of aging. Aging can be understood as random molecular damage that is unrepaired and accumulates over time, resulting in cellular defects and tissue dysfunction. The breakdown of cellular mechanisms, including stem cell exhaustion, genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, altered intercellular communication, and changes in the extracellular matrix is thought to advance the aging process itself. Chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and cancers illustrate a pathologic breakdown in these mechanisms beyond normal aging. The immune system becomes less effective with advancing age. There is a low-level state of chronic inflammation termed inflammaging which is thought to be driven by immunosenescence, the changes in the innate and adaptive immune systems with advancing age that lead to dysregulation and decreased effectiveness of the immune system. These processes of aging lead to expected changes in the form and function of the respiratory system, most notably a loss of lung elasticity, decrease in respiratory muscle strength, increase in ventilation-perfusion mismatching, and stiffening of the vasculature. The astute clinician is aware of these expected findings and does not often attribute dyspnea to aging alone. Maintaining a low threshold to investigate for comorbid disease and understanding how pulmonary disease presents differently in the elderly than in younger adults can improve clinical outcomes. © 2022 American Physiological Society. Compr Physiol 12:3509-3522, 2022.
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Affiliation(s)
- Julia Budde
- New York City Health and Hospitals/Metropolitan Hospital, New York, New York, USA
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Galletti JG, de Paiva CS. Age-related changes in ocular mucosal tolerance: Lessons learned from gut and respiratory tract immunity. Immunology 2021; 164:43-56. [PMID: 33837534 DOI: 10.1111/imm.13338] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/28/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
The ocular surface is the part of the visual system directly exposed to the environment, and it comprises the cornea, the first refractive tissue layer and its surrounding structures. The ocular surface has evolved to keep the cornea smooth and wet, a prerequisite for proper sight, and also protected. To this aim, the ocular surface is a bona fide mucosal niche with an immune system capable of fighting against dangerous pathogens. However, due to the potential harmful effects of uncontrolled inflammation, the ocular surface has several mechanisms to keep the immune response in check. Specifically, the ocular surface is maintained inflammation-free and functional by a particular form of peripheral tolerance known as mucosal tolerance, markedly different from the immune privilege of intraocular structures. Remarkably, conjunctival tolerance is akin to the oral and respiratory tolerance mechanisms found in the gut and airways, respectively. And also similarly, this form of immunoregulation in the eye is affected by ageing just as it is in the digestive and respiratory tracts. With ageing comes an increased prevalence of immune-based ocular surface disorders, which could be related to an age-related impairment of conjunctival tolerance. The purpose of this review was to summarize the present knowledge of ocular mucosal tolerance and how it is affected by the ageing process in the light of the current literature on mucosal immunoregulation of the gut and airways.
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Affiliation(s)
- Jeremias G Galletti
- Innate Immunity Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Cintia S de Paiva
- Department of Ophthalmology, Ocular Surface Center, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
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Castner J, Barnett R, Moskos LH, Folz RJ, Polivka B. Home environment allergen exposure scale in older adult cohort with asthma. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:97-106. [PMID: 32557284 PMCID: PMC7851287 DOI: 10.17269/s41997-020-00335-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Home environmental exposures are a primary source of asthma exacerbation. There is a gap in decision support models that efficiently aggregate the home exposure assessment scores for focused and tailored interventions. Three development methods of a home environment allergen exposure scale for persons with asthma (weighted by dimension reduction, unweighted, precision biomarker-based) were compared, and racial disparity tested. METHODS Baseline measures from a longitudinal cohort of 187 older adults with asthma were analyzed using humidity and particulate matter sensors, allergy testing, and a home environment checklist. Weights for the dimension reduction scale were obtained from factor analysis, applied for loadings > 0.35. Scales were tested in linear regression models with asthma control and asthma quality of life outcomes. Racial disparities were tested using t tests. Scale performance was tested using unadjusted regression analyses with asthma control and asthma quality of life outcomes, separately. RESULTS The 7-item empirically weighted scale demonstrated best performance with asthma control associations (F = 4.65, p = 0.03, R2 = .02) and quality of life (F = 6.45, p = 0.01, R2 = .03) as follows: evidence of roach/mice, dust, mold, tobacco smoke exposure, properly venting bathroom fan, self-report of roach/mice/rats, and access to a HEPA filter vacuum. Pets indoors loaded on a separate scale. Racial differences were observed (t = - 3.09, p = 0.004). CONCLUSION The Home Environment Allergen Exposure Scale scores were associated with racial disparities. Replicating these methods in populations residing in high-risk/low-income housing may generate a clinically meaningful, tailored assessment of asthma triggers. Further consideration for variables that address allergic reactivity and biomarker results is indicated to enhance the potential for a precision prevention score.
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Affiliation(s)
- Jessica Castner
- Castner Incorporated, Stony Point Road, Grand Island, NY, 14072, USA.
| | - Russell Barnett
- Kentucky Institute for the Environment and Sustainable Development, University of Louisville, Louisville, KY, USA
| | | | - Rodney J Folz
- UH Respiratory Health Center, Chief, Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University & University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Barbara Polivka
- University of Kansas School of Nursing, Kansas City, KS, USA
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Clinical Differences between Early- and Late-Onset Asthma: A Population-Based Cross-Sectional Study. Can Respir J 2021; 2021:8886520. [PMID: 33574971 PMCID: PMC7864752 DOI: 10.1155/2021/8886520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background Limited information exists about the nature of late-onset asthma (LOA) without medication intervention when compared to early-onset asthma (EOA). Our goal was to understand how EOA and LOA affect clinical and pathophysiological features. Methods A population-based cross-sectional study was carried out in Zhongshan Hospital (Shanghai, China). EOA and LOA were based on age of diagnosis (before and after age 40 years, respectively). Clinical variables were collected with an emphasis on allergic features, analyzed, related, and compared using one-way ANOVA or Kruskal-Wallis test. Correlations between blood basophils and clinical data were evaluated by Spearman's rank test. Statistical analyses were conducted with SPSS v24.0. Results Of a total of 12,760 adults with cough, sputum, or chest tightness, 90 subjects with EOA (mean age ± standard deviation (SD):28.73 ± 5.89), 111 with LOA (mean age ± SD: 60.25 ± 9.85), and 106 with chronic obstructive pulmonary disease (COPD) (mean age ± SD: 61.58 ± 10.95) were selected. FEV1/FVC (%), FEV1% predicted, and FVC% predicted were all significantly lower in LOA compared to EOA (p < 0.01). The values of post-bronchodilator FEV1 in bronchodilator reversibility testing were higher in the LOA and EOA groups compared to subjects with COPD (p < 0.01). Among allergic features, mite sensitization was most common in EOA patients, followed by LOA and COPD, whereas mold sensitization was more prevalent in LOA than EOA. Moreover, blood eosinophils were a typical feature of asthma in both EOA and LOA compared to COPD and controls (p < 0.01), and there were no differences in blood neutrophils in LOA compared to controls. Interestingly, blood basophils were increased in both EOA (p < 0.01) and LOA (p < 0.05) compared to COPD and controls. This variable correlated with eosinophils in EOA (r = 0.549, p=0.002) but not in LOA. Conclusion LOA is a distinct clinical entity from EOA. In LOA, atopy was less frequent and spirometry values were lower when compared to EOA. In EOA, blood basophils and eosinophils were significantly correlated owing to pathophysiological differences between the two forms of the disease.
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Quirce S, Heffler E, Nenasheva N, Demoly P, Menzies-Gow A, Moreira-Jorge A, Nissen F, Hanania NA. Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy. J Asthma Allergy 2020; 13:743-752. [PMID: 33408487 PMCID: PMC7781019 DOI: 10.2147/jaa.s282205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particularly women, present with asthma for the first time in adult life, tend to be non-allergic and often require higher doses of inhaled corticosteroids (ICS) or are relatively refractory to corticosteroid treatment. In this review, we examine the published literature improve the understanding of the following aspects of LOA: 1) the age cut-off for its diagnosis; 2) its distinct clinical phenotypes, characteristics and risk factors; and 3) its association with allergic comorbidities and conditions. Overall, our review reveals that clinicians and researchers have used multiple age cut-offs to define LOA, with cut-off ages ranging from >12 years to ≥65 years. LOA has also been classified into several distinct phenotypes, some of which drastically differ in their clinical characteristics, course and prognosis. Although LOA has traditionally been considered non-allergic in nature, our review indicates that it is commonly associated with allergic features and comorbidities. Our findings suggest that there is an urgent need for the development of more clear clinical practice guidelines that can provide more clarity on the definition and other aspects of LOA. In addition, the association of LOA and allergy needs to be re-examined to frame a more optimal treatment strategy for patients with LOA.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Natalia Nenasheva
- Department of Allergology and Immunology of Russian Medical Academy for Continuous Medical Education, Moscow, Russian Federation
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | | | - Francis Nissen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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Rhyou HI, Nam YH. Association between cognitive function and asthma in adults. Ann Allergy Asthma Immunol 2020; 126:69-74. [PMID: 32858237 DOI: 10.1016/j.anai.2020.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive deficits are associated with asthma globally; however, the association between cognitive function and asthma has not been fully elucidated. OBJECTIVE To assess the relationship between asthma and cognitive function. METHODS A total of 202 patients with asthma aged older than 18 years were analyzed retrospectively from August 2019 to February 2020. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) test. We compared the associations of clinical parameters with cognitive function (MoCA, ≥23 vs <23) and lung function (forced expiratory volume in 1 second [FEV1], ≥70% vs <70%). RESULTS Of the total participants, 89 (44.1%) indicated cognitive impairment, of whom 23.1% were aged less than 65 years and 72.9% were aged 65 years or older. MoCA scores were significantly different according to age (24.91 ± 3.89 for ages <65 years vs 19.11 ± 5.11 for ages ≥65 years, P < .001) and lung function (23.29 ± 5.17 for FEV1 ≥70% vs 21.23 ± 5.21 for FEV1 <70%, P = .006), but not according to asthma control (22.35 ± 5.38 for nonsevere asthma vs 22.88 ± 4.91 for severe asthma, P = .55). Age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.014-1.13; P = .01), educational status (OR, 6.068; CI, 2.175-16.927; P = .001), and asthma duration (OR, 1.007; CI, 1.001-1.013; P = .02) were significantly associated with cognitive impairment. CONCLUSION Cognitive impairment was largely observed in adults (44.1%) with asthma and was more prevalent in older adults than in younger adults. Longer asthma duration and lower lung function were more associated with cognitive dysfunction.
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Affiliation(s)
- Hyo-In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea.
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Benfante A, Principe S, Battaglia S, Scichilone N. Are biological drugs effective and safe in older severe asthmatics? Expert Opin Drug Saf 2019; 18:369-380. [PMID: 30983432 DOI: 10.1080/14740338.2019.1607838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The treatment of asthma in older ages follows the recommendations of international guidelines for the management of asthma in younger ages, although older age has always represented an exclusion criterion for eligibility to pharmacological trials. This poses a clinical challenge when deciding whether elderly severe asthmatics are candidates for biological drugs. AREAS COVERED The current article has a narrative structure to review the current literature on efficacy and safety of novel pharmacological drugs against immunoglobulins and interleukins that mediate and orchestrate the main inflammatory pathways in severe asthma, in order to explore whether older subjects (i.e. > 65 years of age) are included. EXPERT OPINION Asthma in older ages is not a rare entity, and loss of symptom control is common in most advanced ages. Current evidence from randomized clinical trials (RCTs) on the safety of biological drugs in elderly asthmatics is scarce and does not allow drawing definitive conclusions. An urgent call for studies specifically designed for elderly populations is needed, with the purpose to assess the efficacy and safety of target biological therapies in advanced ages. We envision the design of large multi-center clinical trials to decide whether and when geriatric population could benefit from biological therapies.
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Affiliation(s)
- Alida Benfante
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
| | - Stefania Principe
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
| | - Salvatore Battaglia
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
| | - Nicola Scichilone
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
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Polivka BJ, Folz R, Myers J, Barnett R, Antimisiaris D, Jorayeva A, Beatty B. Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results. Res Nurs Health 2019; 41:336-345. [PMID: 30357896 DOI: 10.1002/nur.21880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/22/2018] [Indexed: 01/05/2023]
Abstract
Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are ≥60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.
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Affiliation(s)
| | - Rodney Folz
- Case Western Reserve University and University Hospital, Cleveland, Ohio
| | - John Myers
- Department of Pediatrics, University of Louisville School, Louisville, Kentucky
| | | | - Demetra Antimisiaris
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Anna Jorayeva
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Bryan Beatty
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
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Alzaabi A, Idrees M, Behbehani N, Khaitov MR, Tunceli K, Urdaneta E, Awad N, Safwat M. Cross-sectional study on Asthma Insights and Management in the Gulf and Russia. Allergy Asthma Proc 2018; 39:430-436. [PMID: 30326990 DOI: 10.2500/aap.2018.39.4180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Asthma is a chronic and complex lung disease that is not completely understood. It involves airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness. The most common symptoms are recurrent wheezing, chest tightness, shortness of breath, and coughing. Objective: The Asthma Insights and Management study gathered information on the burden of asthma in the Gulf region (United Arab Emirates, Kuwait, Saudi Arabia) and Russia. Methods: This was a cross-sectional, multinational, noninterventional, two-phase study that collected data from patients ages ≥ 12 years, through interviews and a survey questionnaire. Phase 1 consisted of survey questions focused on estimating the asthma prevalence in the community. Phase 2 was designed to assess the level of asthma control, asthma-related perceptions and behaviors, and presentation patterns. Data were summarized by using descriptive analyses. Results: Analysis of data of 711 patients revealed that the prevalence of asthma among patients who lived in the community was 7.9% and that 66% subjectively perceived their asthma as being controlled. However, 97% of the patients' asthma were partially controlled or uncontrolled based on the Global initiative for Asthma control classification. Troubling symptoms were daytime coughing (33.3%) and shortness of breath (20.3%). With respect to medications for asthma, 76.2% of the patients reported the use of quick relief medication and 80.8% of maintenance medication during the past 4 weeks. Asthma exacerbation in the past year was reported by 40% of adults and adolescents in the study. Conclusion: The results showed that a significant proportion of the patients experienced bothersome symptoms and that many had a lack of knowledge about asthma control and treatment recommendations, which indicated that there is a need for improvements in patient education and asthma care in the Gulf and Russia regions.
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Affiliation(s)
- Ashraf Alzaabi
- From the Division of Respirology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Majdy Idrees
- Pulmonary Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Musa R. Khaitov
- Immunology Department, National Research Center Institute of Immunology, Federal Medical Biological Agency, Moscow, Russia
| | - Kaan Tunceli
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey
| | - Eduardo Urdaneta
- Global Medical Affairs, Merck & Co. Inc., Kenilworth, New Jersey
| | - Nancy Awad
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
| | - Mohamed Safwat
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
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Abstract
PURPOSE OF REVIEW The review provides insight into recent findings on bedroom allergen exposures, primarily focusing on pet, pest, and fungal exposures. RECENT FINDINGS Large-scale studies and improved exposure assessment technologies, including measurement of airborne allergens and of multiple allergens simultaneously, have extended our understanding of indoor allergen exposures and their impact on allergic disease. Practical, streamlined methods for exposure reduction have shown promise in some settings, and potential protective effects of early-life exposures have been further elucidated through the investigation of specific bacterial taxa. Advances in molecular allergology have yielded novel data on sensitization profiles and cross-reactivity. The role of indoor allergen exposures in allergic disease is complex and remains incompletely understood. Advancing our knowledge of various co-exposures, including the environmental and host microbiome, that interact with allergens in early life will be crucial for the development of efficacious interventions to reduce the substantial economic and social burden of allergic diseases including asthma.
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Budde J, Skloot GS. Is aging a "comorbidity" of asthma? Pulm Pharmacol Ther 2018; 52:52-56. [PMID: 29981459 DOI: 10.1016/j.pupt.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 01/27/2023]
Abstract
The aging population is growing at an unparalleled rate. Asthma is common in the elderly (age over 65 years) and can be more severe with little chance for remission. Asthma in older individuals is often under-diagnosed, misdiagnosed and frequently under-treated. Concomitant medical and psychosocial conditions are more prevalent in the elderly and can obfuscate the presentation of asthma and make it more difficult to assess and manage. While these comorbidities are important in understanding elderly asthma, aging itself can be considered a "comorbidity" since it impacts structural and functional changes in the lung. Structural changes of the aging lung may worsen physiologic function in asthma. The immune system also changes with age, with increased vulnerability to pathogens and differences in airway inflammation, leading to variability in how asthma manifests and responds to treatment. The fact that aging can influence the severity and presentation of asthma along with its diagnosis and management is important for the treating physician to understand. This article will discuss the multitude of factors that justify considering aging as a comorbidity of asthma.
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Affiliation(s)
- Julia Budde
- Division of Pulmonary, Critical Care, & Sleep Medicine Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building 5th Floor, Room 5-20, New York, NY, 10029, USA.
| | - Gwen S Skloot
- Division of Pulmonary, Critical Care, & Sleep Medicine Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building 5th Floor, Room 5-20, New York, NY, 10029, USA.
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Stull JW, Hoffman CC, Landers T. Health Benefits and Risks of Pets in Nursing Homes: A Survey of Facilities in Ohio. J Gerontol Nurs 2018; 44:39-45. [DOI: 10.3928/00989134-20180322-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
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Dunn RM, Busse PJ, Wechsler ME. Asthma in the elderly and late-onset adult asthma. Allergy 2018; 73:284-294. [PMID: 28722758 DOI: 10.1111/all.13258] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/26/2022]
Abstract
Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related physiologic and immunologic changes that complicate the presentation, diagnosis, and management of asthma in the aged population. Evidence suggests that elderly asthmatics are more likely to be underdiagnosed and undertreated. Additionally, elderly patients with asthma have highest rates of morbidity and mortality from their disease than younger patients. The underlying airway inflammation of asthma in this age group likely differs from younger patients and is felt to be non-type 2 mediated. While elderly patients are underrepresented in clinical trials, subgroup analysis of large clinical trials suggests they may be less likely to respond to traditional asthma therapies (ie, corticosteroids). As the armamentarium of pharmacologic asthma therapies expands, it will be critical to include elderly asthmatics in large clinical trials so that therapy may be better tailored to this at-risk and growing population.
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Affiliation(s)
- R. M. Dunn
- Department of Pulmonary and Critical Care Medicine; University of Colorado School of Medicine; Aurora CO USA
- National Jewish Health; Denver CO USA
| | - P. J. Busse
- Division of Clinical Immunology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. E. Wechsler
- Department of Pulmonary and Critical Care Medicine; National Jewish Health; Denver CO USA
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Depression and Asthma Outcomes in Older Adults: Results from the National Health and Nutrition Examination Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017. [DOI: 10.1016/j.jaip.2017.03.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Recent studies suggest that allergic rhinitis is highly prevalent in the elderly population, but is underdiagnosed and undertreated. This review article briefly introduces allergic rhinitis in the elderly (epidemiology and pathophysiology) and identifies the main goals of treatment in these patients with respect to age-related physiological factors, comorbid conditions and polypharmacy. The primary focus of the article is a narrative review of the literature concerning the different types of treatment options in elderly patients aged 60+ years (pharmacological therapy and allergen-specific immunotherapy). The main management trend for allergic rhinitis in elderly patients is the same as the trend in young patients. Second-generation antihistamines and nasal glucocorticosteroids are also the first-line therapies in seniors. In a few trials, allergen-specific immunotherapy for grass pollen or house dust mites has been shown to be effective and safe in patients aged 60 years or older with allergic rhinitis. In conclusion, undertreatment of allergic rhinitis in the elderly is a reality. Pharmacological treatment is quite similar in both older and younger patients with allergic rhinitis.
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Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? A meta-analytic review. J Clin Exp Neuropsychol 2017; 39:965-978. [PMID: 28325118 DOI: 10.1080/13803395.2017.1288802] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators. METHOD Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls. RESULTS There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications. CONCLUSIONS There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.
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Affiliation(s)
- Farzin Irani
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Jordan Mark Barbone
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Janet Beausoleil
- b Division of Allergy and Immunology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Lynn Gerald
- c Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , AZ , USA.,d Asthma and Airways Disease Research Center , University of Arizona , Tucson , AZ , USA
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Allergic rhinitis, bronchial asthma and other allergies in patients with Alzheimer's disease: unnoticed issue. Postepy Dermatol Alergol 2016; 33:353-358. [PMID: 27881942 PMCID: PMC5110626 DOI: 10.5114/ada.2016.62842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Allergic diseases are becoming more prevalent in elderly patients. Allergic diseases have been observed in patients with Alzheimer's disease (AD). The prevalence of atopic bronchial asthma, allergic rhinitis and atopic dermatitis was analyzed in such elderly Polish population. AIM Analysis of the presence of allergic diseases in the patients with AD in Poland, including asthma, allergic rhinoconjunctivitis and atopic dermatitis. MATERIAL AND METHODS The recruitment of subjects with AD was conducted at 6 sites representative of Polish rural and urban areas, and 1060 subjects with a mean age of 69.2 ±5.1 years were screened. Medical examinations, an original questionnaire, skin prick testing for common aeroallergens and appropriate serum-specific IgE assays were performed. RESULTS Probable atopy was diagnosed in 234 (22.1%) analyzed patients, including 127 women (21.5% of women) and 234 men (22.8% of men). The average prevalence associated with age and sex in this population for bronchial asthma was 2.9%, atopic dermatitis/eczema was 0.6%, seasonal allergic rhinitis was 6.6%, perennial allergic rhinitis was 11.1% and polymorphous atopic disease was 4.4%. The most frequent positive results were recorded for the following allergens: mixed grass, Dermatophagoides pteronyssinus, Dermatophagoides farinae and Alternaria. CONCLUSIONS One-fifth of diagnosed patients with AD have allergic disease requiring treatment.
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Kao YH, Wu SC. STROBE-compliant article: Is continuity of care associated with avoidable hospitalization among older asthmatic patients? Medicine (Baltimore) 2016; 95:e4948. [PMID: 27661052 PMCID: PMC5044922 DOI: 10.1097/md.0000000000004948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Continuity of care (COC) has a proven relationship with health care outcomes. However, evidence regarding an association between COC and avoidable hospitalization for elderly patients with asthma is insufficient.A retrospective cohort study was performed using Taiwanese National Health Insurance claim data from 2004 to 2013. Patients were retrospectively followed for 2 years; the COC index (COCI) for asthma was measured in the 1st year, and avoidable hospitalization for asthma and follow-up time were determined in the subsequent year. Cox proportional hazards regression was employed to examine hazard ratios (HRs) between COC and avoidable hospitalization for asthma after adjustment for confounding factors. Adjusted HR (aHR) was also calculated by stratifying each variable to investigate whether the effect of COC on hospitalization for asthma was avoidable and how this varied across levels of COCI.Of 3356 patients included in this study, 1648 patients (49%) had a COCI of 1, and the average COCI was 0.73. Compared with patients with high COC (COCI = 1), those with low COC (COCI < 0.5) had a significantly higher risk of avoidable hospitalization for asthma (aHR = 2.68; 95% confidence interval [CI]: 1.55-4.63). In addition, after stratified analysis, we determined that COC plays a much more important role for patients who were women, had low insurance premiums, and had no comorbidities.High continuity of ambulatory asthma care is linked to a reduced risk of avoidable hospitalization for asthma in elderly asthmatic patients.
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Affiliation(s)
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
- Correspondence: Shiao-Chi Wu, 155 Li-Nong St. Sec 2, Peitou, Taipei, Taiwan (e-mail: )
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Kawamatawong T, Siripongpun S, Rerkpattanapipat T. Role of eosinophilic inflammation and atopy in elderly asthmatic patients. Asia Pac Allergy 2016; 6:181-6. [PMID: 27489791 PMCID: PMC4967619 DOI: 10.5415/apallergy.2016.6.3.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Asthma in the elderly is severe and associated with poor treatment outcome. Although atopy has an important role in pathogenesis, its role in the elderly is unclear, partly due to immune senescence. Objective We aimed to examine the associations of Th2-mediated inflammation with asthma severity in the elderly. Methods Consecutive asthmatics older than 60 years without severe exacerbation within 8 weeks were enrolled. Atopic status was determined by positive serum specific IgE or skin prick test to common aeroallergens. Serum total IgE was measured simultaneously to exhaled fractional concentration of nitric oxide (FeNO). Asthma control level was assessed by using Thai Asthma Control Test (ACT) score. Results Total of 44 elderly asthmatic patients were enrolled. The mean age was 68.9 years and mean age of asthma diagnosis was 46.6 years. Seventy-seven percent of patients were female. Atopic status was found in 45.5% of patients. Uncontrolled asthma classified as ACT score < 20 was noted in 25% of elderly asthma, but its association with either high serum total IgE (≥120 IU/mL), high FeNO (≥50 ppb) or atopic status was not detected. Conclusion One-fourth of elderly asthmatics were clinically uncontrolled, while atopy was confirmed in 45.5%. Neither high total IgE, high FeNO nor atopic status was associated with uncontrolled asthma in the elderly. Other factors might play role in asthma severity in the elderly, and has to be further investigated.
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Affiliation(s)
- Theerasuk Kawamatawong
- Division of Pulmonary and Critical Care Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sitthisak Siripongpun
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ticha Rerkpattanapipat
- Division of Allergy, Immunology and Rheumatology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Ridolo E, Caminati M, Martignago I, Melli V, Salvottini C, Rossi O, Dama A, Schiappoli M, Bovo C, Incorvaia C, Senna G. Allergic rhinitis: pharmacotherapy in pregnancy and old age. Expert Rev Clin Pharmacol 2016; 9:1081-9. [PMID: 27177184 DOI: 10.1080/17512433.2016.1189324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) affects 20-30% of women in reproductive age and may worsen during pregnancy. About 10% of the elderly suffer from AR, and it could be under-diagnosed in these patients. Many drugs are currently available, however AR treatment during pregnancy and old age represents a challenging issue. AREAS COVERED A review of the literature on the topic has been performed. Expert commentary: In pregnancy, drug avoidance should be carefully balanced with the need for AR optimal control. Topical drugs are suggested as a first approach. The safety and tolerability profile of second-generation antihistamines is well supported. If allergen immunotherapy (AIT) is ongoing and well tolerated, there is no reason for stopping it. AIT initiation in pregnancy is not recommended. For elderly patients, no specific concerns have been highlighted regarding topical treatments, except from nasal decongestionants. Second generation antihistamines are generally well tolerated. Old age should not preclude AIT.
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Affiliation(s)
- E Ridolo
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - M Caminati
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - I Martignago
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - V Melli
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - C Salvottini
- c Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | - O Rossi
- d Allergy Unit , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy
| | - A Dama
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - M Schiappoli
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - C Bovo
- e Medical Direction , Verona University Hospital , Verona , Italy
| | - C Incorvaia
- f Allergy/Pulmonary Rehabilitation , ICP Hospital , Milano , Italy
| | - G Senna
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
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Abstract
UNLABELLED Co-morbidities are a significant problem in the elderly population but are rarely presented and analyzed for interdependencies among the various coexisting chronic diseases. OBJECTIVE The aim of this study was to present a profile of comorbidities in elderly patients with and without asthma and COPD. METHODS Respondents were recruited at 20 sites in Poland. Stratified random sampling from patient databases resulted in 15,973 patients older than 60 years of age. A retrospective analysis of medical history and ICD-10 codes was performed. In addition, patients underwent a spirometry test with a bronchial reversibility test and were administered questionnaires on the prevalence of chronic diseases by doctors. RESULTS The study population consisted of 1023 asthmatic patients, 1084 patients with COPD and 1076 control subjects without any signs of bronchoconstriction and with correct spirometry. Patients with asthma exhibited a similar distribution of cardiovascular and metabolic co-morbidities as the control group. However, asthmatic patients had a higher prevalence of arterial hypertension and depression with an odds ratio (OR) = 1.48 (95% CI: 1.38-1.62) and OR = 1.52 (95% CI: 1.44-1.68), respectively. Coronary disease (OR = 2.12; 95% CI: 1.97-2.33), cor pulmonale (OR = 3.1; 95% CI: 2.87-3.22) and heart failure (OR = 2.71; 95% CI: 2.64-3.11) were predominantly observed in patients with COPD. Patients with severe asthma exhibited a greater predisposition to cardiovascular and neuropsychiatric diseases. CONCLUSION Asthma coexisted frequently with arterial hypertension and depression in elderly patients. Patients with COPD have a more exaggerated profile of coexisting diseases, specifically cardiovascular problems.
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Affiliation(s)
- Andrzej Bozek
- a Clinical Department of Internal Disease , Allergology and Dermatology in Zabrze, Medical University of Silesia , Katowice , Poland
| | - Barbara Rogala
- b Clinical Department of Internal Disease , Allergology and Immunology, Medical University of Silesia , Katowice , Poland
| | - Piotr Bednarski
- c National Institute of Geriatrics, Rheumatology and Rehabilitation , Warszawa , Poland
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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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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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Kannan JA, Bernstein DI, Bernstein CK, Ryan PH, Bernstein JA, Villareal MS, Smith AM, Lenz PH, Epstein TG. Significant predictors of poor quality of life in older asthmatics. Ann Allergy Asthma Immunol 2015. [PMID: 26208758 DOI: 10.1016/j.anai.2015.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Morbidity and mortality from asthma are high in older adults and quality of life (QOL) might be lower, although standardized measurements of QOL have not been validated in this population. OBJECTIVE To determine predictors of asthma-related QOL in older adults. METHODS Allergy and pulmonary outpatients (n = 164) at least 65 years old with an objective diagnosis of asthma completed the Mini-Asthma Quality of Life Questionnaire (mAQLQ). Demographics, medical history, and mean value for daily elemental carbon attributable to traffic, a surrogate for diesel exposure, were obtained. Regression analysis was used to determine predictors of mAQLQ scores. RESULTS Total mAQLQ (mean ± SD 5.4 ± 1.1) and symptom, emotional, and activity domain scores were similar to those of younger populations, whereas environmental domain scores (4.4 ± 1.7) appeared lower. Poorer mAQLQ scores were significantly associated with emergency department visits (adjusted β [aβ] = -1.3, where β values indicate the strength and direction of association, P < .0001) and with poorer scores on the Asthma Control Questionnaire (aβ = -0.7, P < .0001). Greater ECAT exposure (aβ = -1.6, P < .02), female sex (aβ = -0.4, P < .006), body mass index of at least 30 kg/m(2) (aβ = -0.4, P < .01), gastroesophageal reflux (aβ = -0.4, P < .01), nonatopic status (aβ = -0.5, P < .002), and asthma onset before 40 years of age (aβ = -0.5, P < .004) were significantly associated with poorer mAQLQ scores. CONCLUSION The mAQLQ scores in older adults with stable asthma were similar to those in younger populations and were predictive of other measurements of asthma control, verifying that the mAQLQ is an appropriate tool in older adults with asthma. Traffic pollution exposure was the strongest predictor of poorer asthma-related QOL in older adults with asthma.
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Affiliation(s)
- Jennifer A Kannan
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David I Bernstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Clinical Research Center, LLC, Cincinnati, Ohio
| | | | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Clinical Research Center, LLC, Cincinnati, Ohio
| | - Manuel S Villareal
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew M Smith
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio
| | - Peter H Lenz
- Division of Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Tolly G Epstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio.
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Maradey-Romero C, Prakash R, Lewis S, Perzynski A, Fass R. The 2011-2014 prevalence of eosinophilic oesophagitis in the elderly amongst 10 million patients in the United States. Aliment Pharmacol Ther 2015; 41:1016-22. [PMID: 25809664 DOI: 10.1111/apt.13171] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 02/18/2015] [Accepted: 03/03/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) is primarily diagnosed by clinicians. There are less than a handful of epidemiological studies in EoE that have included elderly patients (>65 years). AIM To determine the prevalence of elderly subjects among EoE patients and compare their clinical presentation, associated conditions and treatment modalities with adult and paediatric EoE patients. METHODS A large nationwide database (Explorys) between January 2011 and January 2014 was used. The term 'Eosinophilic Oesophagitis' was used in the Explorys search tool. The patient population was divided into three groups, Paediatric (<18 years), Adult (18-65 years) and Elderly (>65 years). RESULTS We identified 4840 patients coded as EoE. The total estimated prevalence was 50.6 cases per 100 000 patients (0.05%). A total of 360 cases (7.44%) were elderly patients with an estimated prevalence rate of 18.6 cases per 100 000. Across all age groups, the majority of EoE patients were Caucasians and males. A significantly greater proportion of older patients had concomitant GERD. Dysphagia was the most common symptom among elderly EoE patients as compared with the paediatric EoE patients (P < 0.001). The proportion of elderly EoE patients with food allergies or asthma was significantly lower as compared with paediatric and adult EoE patients (P < 0.001). Oesophageal dilation and/or proton pump inhibitor treatment were the most commonly used therapeutic modalities in elderly EoE patients. CONCLUSION Eosinophilic oesophagitis is uncommon in elderly subjects and the clinical presentation is markedly different as compared with adults or the paediatric population.
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Affiliation(s)
- C Maradey-Romero
- Division of Gastroenterology and Hepatology, The Esophageal and Swallowing Center, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
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Milanese M, Di Marco F, Corsico AG, Rolla G, Sposato B, Chieco-Bianchi F, Costantino MT, Crivellaro MA, Guarnieri G, Scichilone N. Asthma control in elderly asthmatics. An Italian observational study. Respir Med 2014; 108:1091-9. [PMID: 24958604 DOI: 10.1016/j.rmed.2014.05.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exponential increase of individuals aged >64 yrs is expected to impact the burden of asthma. We aimed to explore the level of asthma control in elderly subjects, and factors influencing it. METHODS A multicenter observational study was performed on consecutive patients >64 years old with a documented physician-diagnosis of asthma. Sixteen Italian centers were involved in this 6-month project. FINDINGS A total of 350 patients were enrolled in the study. More than one-third of elderly asthmatic patients, despite receiving GINA step 3-4 antiasthmatic therapy, had an Asthma Control Test score ≤19, with a quarter experiencing at least one severe asthma exacerbation in the previous year. Twenty-nine percent of patients (n = 101) were classified as having Asthma-COPD Overlap Syndrome (ACOS) due to the presence of chronic bronchitis and/or CO lung diffusion impairment. This subgroup of patients had lower mean Asthma Control Test scores and more exacerbations compared to the asthmatic patients (18 ± 4 compared to 20 ± 4, p < 0.01, and 43% compared to 18%, p < 0.01, respectively). Modified Medical Research Council dyspnea mMRC scores and airway obstruction, assessed on the basis of a FEV(1)/FVC ratio below the lower limit of normal, were more severe in ACOS than in asthma, without any difference in responses to salbutamol. In a multivariate analysis, the mMRC dyspnea score, FEV(1)% of predicted and the coexistence of COPD were the only variables to enter the model. INTERPRETATION Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control.
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Affiliation(s)
- M Milanese
- Struttura Complessa di Pneumologia, Azienda Sanitaria Locale 2 Savonese, Pietra Ligure, Italy.
| | - F Di Marco
- Struttura Complessa di Pneumologia Ospedale S. Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - A G Corsico
- Struttura Complessa di Pneumologia, Fondazione IRCCS Policlinico San Matteo, Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | - G Rolla
- Allergologia e Immunologia Clinica Università di Torino, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - B Sposato
- Pneumologia, Azienda Ospedale Misericordia, Grosseto, Italy
| | - F Chieco-Bianchi
- Struttura Complessa di Fisiopatologia Respiratoria, Azienda Ospedaliera di Padova, Padova, Italy
| | - M T Costantino
- Struttura Complessa di Pneumologia, Azienda Ospedaliera Carlo Poma di Mantova, Mantova, Italy
| | - M A Crivellaro
- Servizio di Allergologia, Medicina del Lavoro, Azienda Ospedaliera Università degli Studi di Padova, Padova, Italy
| | - G Guarnieri
- Fisiopatologia Respiratoria, Medicina del Lavoro, Università di Padova, Padova, Italy
| | - N Scichilone
- DIBIMIS, Università degli Studi di Palermo, Palermo, Italy
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Yáñez A, Cho SH, Soriano JB, Rosenwasser LJ, Rodrigo GJ, Rabe KF, Peters S, Niimi A, Ledford DK, Katial R, Fabbri LM, Celedón JC, Canonica GW, Busse P, Boulet LP, Baena-Cagnani CE, Hamid Q, Bachert C, Pawankar R, Holgate ST. Asthma in the elderly: what we know and what we have yet to know. World Allergy Organ J 2014; 7:8. [PMID: 25152804 PMCID: PMC4137434 DOI: 10.1186/1939-4551-7-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/02/2014] [Indexed: 02/07/2023] Open
Abstract
In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.
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Affiliation(s)
- Anahí Yáñez
- Investigaciones en Alergia y Enfermedades Respiratorias- InAER, Buenos Aires, Argentina
| | - Sang-Hoen Cho
- Department of Internal Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Joan B Soriano
- Programa de Epidemiologia e Investigacion Clinica, Fundación Caubet-CIMERA, Illes Balears, Spain
| | - Lanny J Rosenwasser
- Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missoui, United States of America
| | - Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Klaus F Rabe
- Krankenhaus Lungen Clinic, Grosshansdorf, Germany
| | - Stephen Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Akio Niimi
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kyoto, Japan
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Medicine, Morsani University of South Florida College of Medicine, James A Haley Veterans Hospital, Tampa, Florida, United States of America
| | - Rohit Katial
- Division of Allergy and Immunology, National Jewish Health, Denver, Colorado, United States of America
| | - Leonardo M Fabbri
- Department of Oncology, Haematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania, United States of America
| | | | - Paula Busse
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Louis-Phillippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, (Quebec Heart and Lung Institute, Laval University), Quebéc, Canada
| | - Carlos E Baena-Cagnani
- Centre for Research in Respiratory Medicine, Catholic University of Córdoba, Córdoba, Argentina
| | - Qutayba Hamid
- Meakins-Christie Laboratories, McGill University, Quebéc, Canada
| | - Claus Bachert
- Upper Airways Research Laboratory (URL), Clinics ENT-Department, University Hospital Ghent, Ghent, Belgium
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Stephen T Holgate
- Faculty of Medicine Clinical and Experimental Sciences, University of Southampton, Hampshire, United Kingdom
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Pite H, Pereira AM, Morais-Almeida M, Nunes C, Bousquet J, Fonseca JA. Prevalence of asthma and its association with rhinitis in the elderly. Respir Med 2014; 108:1117-26. [PMID: 24877896 DOI: 10.1016/j.rmed.2014.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma and rhinitis are frequent respiratory diseases in children and adults. Despite the increase in the aging population, there are few epidemiologic data on both diseases in the elderly. So far, no population-based study has analyzed the association between asthma and rhinitis symptoms and severity in this age group. This study aimed to estimate the prevalence of physician-diagnosed asthma in the population aged ≥65 years in mainland Portugal and to evaluate its association with the presence and classification of rhinitis according to ARIA recommendations, in this age group. METHODS A cross-sectional, nationwide, population-based survey of individuals aged ≥65 years, living in mainland Portugal was performed. RESULTS Data were obtained from 3678 respondents. The prevalence of physician-diagnosed asthma was 10.9% (95% confidence interval (95%CI) 9.9-11.9). The frequency of asthma diagnosis increased with the number of nasal symptoms (p < 0.001). A strong association between asthma and rhinitis was found (odds ratio (OR) 13.86 (95%CI 10.66-18.02)). The strength of this association increased with the persistence and severity of rhinitis, being particularly high in elderly subjects with moderate-severe persistent rhinitis (OR 39.9 (95%CI 27.5-58.0)). CONCLUSIONS Asthma is common in the elderly and strongly associated with rhinitis. The OR for asthma is especially high in persistent and severe ARIA classification rhinitis types. This study strengthens the need for an integrated assessment of asthma together with rhinitis in the elderly.
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Affiliation(s)
- H Pite
- Hospital CUF-Descobertas and Hospital CUF-Infante Santo, Immunoallergy Department, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; CEDOC, Faculty of Medical Sciences, Pharmacology Department, Lisbon, Portugal.
| | - A M Pereira
- Hospital CUF-Descobertas and Hospital CUF-Infante Santo, Immunoallergy Department, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; Hospital S. João EPE, Allergy and Clinical Immunology Department, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Health Information and Decision Sciences Department, Porto, Portugal; Instituto e Hospital CUF Porto, Allergy Unit, Porto, Portugal
| | - M Morais-Almeida
- Hospital CUF-Descobertas and Hospital CUF-Infante Santo, Immunoallergy Department, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
| | - C Nunes
- Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - J Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
| | - J A Fonseca
- Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; Hospital S. João EPE, Allergy and Clinical Immunology Department, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Health Information and Decision Sciences Department, Porto, Portugal; Instituto e Hospital CUF Porto, Allergy Unit, Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
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Al-Alawi M, Hassan T, Chotirmall SH. Advances in the diagnosis and management of asthma in older adults. Am J Med 2014; 127:370-8. [PMID: 24380710 DOI: 10.1016/j.amjmed.2013.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
Global estimates on aging predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis, and management in clinical practice require optimization. This review aims to provide an update for clinicians, highlighting advances in the understanding of the aging process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Aging impacts airway responses and immune function, and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence, and side-effect profiles persist in the older patient, while novel recording devices developed to aid detection of an adequate inhalation evaluate treatment effectiveness and compliance more accurately than previously attainable. Anticytokine therapies improve control of brittle asthma, while bronchial thermoplasty is an option in refractory cases. Multidimensional intervention strategies prove best in the management of asthma in the older adult, which remains a condition that is not rare but rarely diagnosed in this patient population.
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Affiliation(s)
- Mazen Al-Alawi
- Department of Medicine, Our Lady of Lourdes Hospital, Navan, Republic of Ireland
| | - Tidi Hassan
- Department of Respiratory Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Republic of Ireland
| | - Sanjay H Chotirmall
- Department of Medicine, St James's Hospital, James's Street, Dublin 8, Republic of Ireland.
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Robitaille C, Boulet LP. [Asthma in the elderly]. Rev Mal Respir 2014; 31:478-87. [PMID: 25012034 DOI: 10.1016/j.rmr.2014.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/16/2014] [Indexed: 01/09/2023]
Abstract
Asthma is a common condition in the elderly although often confounded with chronic obstructive pulmonary disease (COPD) in this population. Asthma in the elderly seems to represent a specific phenotype characterized by more severe, but often less perceived, airway obstruction, a neutrophilic or mixed-type of airway inflammation and frequent comorbidities. Patients aged 65 years and over have an increased asthma-related morbidity and mortality compared to younger patients, probably due to difficulties in regard to diagnosis, assessment of the disease severity and treatment. Research is urgently needed to determine the optimal treatment of the aged patient. In this document we will review the state of knowledge on this topic and discuss the challenges of multidisciplinary asthma management in the elderly.
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Affiliation(s)
- C Robitaille
- Institut universitaire de cardiologie et de pneumologie de Québec, université Laval, 2725, chemin Sainte-Foy, G1V 4G5 Québec, QC, Canada
| | - L-P Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, université Laval, 2725, chemin Sainte-Foy, G1V 4G5 Québec, QC, Canada.
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Baena-Cagnani CE, Larenas-Linnemann D, Teijeiro A, Canonica GW, Passalacqua G. Will sublingual immunotherapy offer benefit for asthma? Curr Allergy Asthma Rep 2014; 13:571-9. [PMID: 24022465 DOI: 10.1007/s11882-013-0385-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Evidence shows that sublingual immunotherapy (SLIT) is indicated in patients with allergic rhinitis (AR). In this article we discuss whether SLIT could offer benefit for children and adults with asthma.We reviewed individual trials on SLIT in asthmatic patients, but also asthma data reported in some SLIT trials conducted in AR patients. Findings were complemented with data from systematic reviews and metaanalysis on the subject since 2000 and some guidelines that mention immunotherapy for asthma treatment. In AR patients with concomitant persistent asthma, SLIT reduces medication needs while maintaining symptom control. This holds especially true for house dust mite SLIT. Data on pollen SLIT and lung symptom improvement with SLIT, however, are less convincing. Therefore, we suggest SLIT should be added as an optional add-on therapy for patients with asthma whenever a causative allergen has been demonstrated and AR is associated with asthma. For the future, SLIT should be studied in specifically designed asthma studies in allergic asthmatics without AR.
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Filipowski M, Bozek A, Kozlowska R, Czyżewski D, Jarzab J. The influence of hospitalizations due to exacerbations or spontaneous pneumothoraxes on the quality of life, mental function and symptoms of depression and anxiety in patients with COPD or asthma. J Asthma 2013; 51:294-8. [PMID: 24188733 DOI: 10.3109/02770903.2013.862543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with bronchial asthma or chronic obstructive pulmonary disease (COPD) frequently have a low quality of life (QoL) in addition to depression symptoms. The aim of this study was to compare the QoL, depression symptoms, mental function and anxiety in patients with asthma or COPD exacerbations or spontaneous pneumothoraxes (SP) to patients with stable disease. MATERIALS AND METHODS Patients with a confirmed diagnosis of severe (III degree) bronchial asthma or COPD were included in this study. Prospective observations of asthma or COPD exacerbations or SP were performed over a three-year period. QoL was assessed using St. George's Respiratory Questionnaire (SGRQ). In addition, the AQ20 questionnaire (AQ20), the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE) were administered. RESULTS A total of 233 patients (112 with asthma and 121 with COPD; mean age 57.9 ± 11.9 years) were included in the study. Patients with COPD or asthma had a low QoL as estimated by the SGRQ (mean ± SD: 27.5 ± 12.9 and 25.1 ± 10.2 for asthma and COPD, respectively). Asthma exacerbations, COPD exacerbations or SP requiring hospitalization were associated with lower SGRQ scores over the three-year observation period (41.5 ± 11.7, 57.9 ± 14.3 and 65.3 ± 11.4, respectively). The mean MMSE score significantly decreased after an asthma exacerbation compared to the baseline (29.9 ± 2.1 versus 27.2 ± 3.1; p < 0.05). The mean MMSE score decreased after COPD exacerbations (28.5 ± 0.9 versus 26.9 ± 1.2; p < 0.05) and after COPD with an SP event (28.8 ± 1.2 versus 24.1 ± 2.2; p < 0.05). CONCLUSION Low QoL and mental impairment were observed in patients with asthma and COPD. In addition, the QoL significantly decreased following hospitalizations due to exacerbations or SP.
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Affiliation(s)
- Marek Filipowski
- Clinical Department of Chest Surgery, Medical University of Silesia , Zabrze , Poland
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Asthma Control and Its Relationship with Obstructive Sleep Apnea (OSA) in Older Adults. SLEEP DISORDERS 2013; 2013:251567. [PMID: 24307949 PMCID: PMC3836422 DOI: 10.1155/2013/251567] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023]
Abstract
Background/Objectives. Asthma in older individuals is poorly understood. We aimed to characterize the older asthma phenotype and test its association with obstructive sleep apnea (OSA). Design. Cross-sectional. Setting. Pulmonary and Asthma/Allergy clinics. Participants. 659 asthma subjects aged 18–59 years (younger) and 154 aged 60–75 (older). Measurements. Sleep Apnea scale of Sleep Disorders Questionnaire (SA-SDQ), asthma severity step (1–4, severe if step 3 or 4), established OSA diagnosis, continuous positive airway pressure (CPAP) use, and comorbidities. Results. Older versus younger had worse control, as assessed by asthma step, lung function, and inhaled corticosteroid use. Among older subjects, after controlling for known asthma aggravators, OSA diagnosis was the only factor robustly associated with severe asthma: on average, OSA was associated with nearly 7 times greater likelihood of severe asthma in an older individual (OR = 6.67). This relationship was of greater magnitude than in younger subjects (OR = 2.16). CPAP use attenuated the likelihood of severe asthma in older subjects by 91% (P = 0.005), much more than in the younger asthmatics. Conclusion. Diagnosed OSA increases the risk for worse asthma control in older patients, while CPAP therapy may have greater impact on asthma outcomes. Unrecognized OSA may be a reason for poor asthma control, particularly among older patients.
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Caminati M, Bettoncelli G, Magnoni MS, Rizzi A, Testi R, Passalacqua G, De Marco R, Caramori G, Senna G. The level of control of mild asthma in general practice: an observational community-based study. J Asthma 2013; 51:91-6. [PMID: 24040887 DOI: 10.3109/02770903.2013.843098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present community-based study was to evaluate the level of asthma control in patients with mild asthma, regularly treated with inhaled steroids (ICS). METHOD This observational cross-sectional study included patients registered in the general practitioner (GP) database and with at least three prescriptions of ICS in the last 12 months. Patients were asked to refer to the doctor's office for a standardised interview. The level of asthma control was self-measured by the patients using the Asthma Control Test (ACT)™ (Quality Metric, Inc.). RESULTS The study included 950 asthmatic patients, referred by 540 GPs: 54.5% were females, mean age was 51 (±19.1) years; 59.5% were non-smokers, 22.5% were current smokers and 18.0% were former smokers; 81.1% of the patients were on ICS in the last 4 weeks. Only 38.6% of patients had a spirometry in the last 12 months. According to the ACT, 13.7% of the asthmatic patients were totally controlled, 51.0% well controlled, and 35.3% poorly controlled. Smoking habit, older age (>60) and living in Central or Southern Italy were associated with poorer control. In the last 12 months 4.5% of patients had an asthma-related hospitalisation, 5.3% an emergency visit and 18.9% a specialist visit. CONCLUSIONS More than one of three patients had poor asthma control, despite being considered by their GPs as mild asthmatics and treated with ICS. Asthmatic patients need to be regularly re-evaluated. Treatment is often inadequate and should be targeted to improve control and reduce asthma morbidity (SAM104964).
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Affiliation(s)
- Marco Caminati
- Allergy Unit, Verona University Hospital , Verona , Italy
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Morais-Almeida M, Pite H, Pereira AM, Todo-Bom A, Nunes C, Bousquet J, Fonseca J. Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal. Allergy 2013; 68:1150-7. [PMID: 23919243 DOI: 10.1111/all.12207] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nationwide epidemiologic data on rhinitis in the elderly do not exist. This study aimed to estimate the prevalence of rhinitis in the population aged 65 years or above in mainland Portugal and to characterize and classify rhinitis in this age group. METHODS Cross-sectional, nationwide, population-based survey of citizens aged 65 years or above, living in mainland Portugal. Current rhinitis (CR) was defined as the presence of at least two symptoms: 'repeated sneezing and itchy nose', 'blocked nose for more than one whole hour', or 'runny nose when not having a cold or flu', either usually or in the last 12 months. Rhinitis severity was assessed using a visual analogue scale; rhinitis was classified according to ARIA. RESULTS Data were obtained from 3678 responders (92.5% response rate). The prevalence of CR was 29.8% (95% confidence interval (CI): 28.4%-31.3%): 49.1% had mild intermittent, 7.0% mild persistent, 27.5% moderate-severe intermittent, and 16.4% moderate-severe persistent rhinitis. Only 38.6% of patients with CR had been physician diagnosed and 38.7% were under treatment for this disease in the previous year. Allergic conjunctivitis symptoms were referred by 68.6% of subjects with CR (rhinoconjunctivitis population prevalence, 20.5% (95% CI: 19.2%-21.8%)). CONCLUSIONS Rhinitis and rhinoconjunctivitis are common but underdiagnosed and undertreated diseases in the geriatric population. This was the first nationwide epidemiological survey classifying rhinitis according to ARIA guidelines in this age group. More than 40% of old-age patients presented moderate-severe disease.
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Affiliation(s)
| | | | | | | | | | - J. Bousquet
- Department of Allergy and Respiratory Diseases; University Hospital and INSERM; Montpellier; France
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Wüthrich B, Schmid-Grendelmeier P, Schindler C, Imboden M, Bircher A, Zemp E, Probst-Hensch N. Prevalence of atopy and respiratory allergic diseases in the elderly SAPALDIA population. Int Arch Allergy Immunol 2013; 162:143-8. [PMID: 23921456 DOI: 10.1159/000351416] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Because of changing world demographics, the elderly population is steadily increasing. Few studies have assessed the prevalence of atopy and allergic diseases in elderly persons with objective measures. The aim of this paper is to describe the prevalence of atopy, self-reported allergic rhinitis and doctor's diagnosed asthma in persons over the age of 60 in Switzerland. METHODS The cross-sectional examination of the Swiss Study on Air Pollution and Health in Adults (SAPALDIA 1), performed in 1991, included 9,651 adults aged 18-60 years. In 2001-2002 the same subjects were invited for a follow-up examination (SAPALDIA 2). Serum samples collected at baseline and follow-up were tested for specific IgE sensitization with the Phadiatop® (Phadia, Uppsala, Sweden, now Thermo Fisher Scientific) assay containing a mixture of common respiratory allergens (grass, birch, mugwort, Parietaria and olive pollen, dog, cat, horse, Cladosporium herbarum, house dust mite and flour mite). Atopy was defined as a positive result in the Phadiatop test according to guidelines by the manufacturer. The prevalence rates of atopy, self-reported allergic rhinitis and doctor's diagnosed asthma were evaluated by sex and age group (≤60 or >60 years). RESULTS 7,667 subjects (men = 3,692/women = 3,975) participated in the follow-up by responding to a detailed questionnaire (80% of SAPALDIA 1 participants). Phadiatop results were available for 5,835 participants (men = 2,839/women = 2,996). Prevalence rates of atopy (Phadiatop positive) were 36.4% in men aged ≤60 years versus 26.2% in men aged >60 years and 30.6 and 18.1% in women, respectively (both p < 0.001). Prevalence rates of self-reported allergic rhinitis in subjects >60 years old were 13.0% for men and 15.4% for women (p = 0.12), and for doctor's diagnosed asthma 6.6% versus 7.6%, respectively (p = 0.40). Both rhinitis and asthma prevalences were higher in persons <60 years. The results were not sensitive to potential bias from nonparticipation at follow-up as demonstrated by imputation of sex- and age-specific allergic rhinitis and asthma among nonparticipants. CONCLUSIONS According to our estimates, the prevalence of allergic rhinitis among persons aged between 60 and 70 years in Switzerland in the present cohort is of the order of 13-15% and should not be underestimated, although it is lower than in age groups ≤60 years.
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Bożek A, Filipowski M, Fischer A, Jarzab J. Characteristics of atopic bronchial asthma in seniors over 80 years of age. BIOMED RESEARCH INTERNATIONAL 2013; 2013:689782. [PMID: 23984398 PMCID: PMC3747429 DOI: 10.1155/2013/689782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Asthma in the elderly is an important public health problem. The aim of this study was to assess the prevalence and characteristics of asthma in seniors. MATERIALS AND METHODS The study involved 105 people of at least 80 years of age (mean age of 84.1 ± 3.9 years) selected from a group of 1860 individuals. Spirometry, the methacholine test, allergy diagnosis, a measurement of exhaled nitric oxide, and administration of the asthma quality of life questionnaire (AQLQ) were performed. RESULTS The average morbidity of asthma in the study population of elderly people (at least 80 years of age) was 5.6% (105 people) of the confidence interval (95% CI: 5.1-6.0). In the study group, 34% of the elderly asthmatics had uncontrolled asthma, 47% had partly controlled asthma, and only 24% had fully controlled asthma. Allergy to house dust mites was predominant. The average total score on the AQLQ was 4.12 ± 0.72 (arithmetic mean ± standard deviation) for the seniors, which was significantly lower than the score for the young. CONCLUSION The pathogenesis, natural history, and value of the basic diagnostic methods of asthma in the elderly are similar to those observed in younger age groups.
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Affiliation(s)
- Andrzej Bożek
- Clinical Department of Internal Medicine, Dermatology and Allergology, Medical University of Silesia, M. Sklodowskiej-Curie 10, 41-800 Zabrze, Poland
| | - Marek Filipowski
- Clinical Department of Chest Surgery, Medical University of Silesia, 41-880 Zabrze, Poland
| | | | - Jerzy Jarzab
- Clinical Department of Internal Medicine, Dermatology and Allergology, Medical University of Silesia, M. Sklodowskiej-Curie 10, 41-800 Zabrze, Poland
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Baptist AP, Ross JA, Clark NM. Older adults with asthma: does age of asthma onset make a difference? J Asthma 2013; 50:836-41. [PMID: 23782329 DOI: 10.3109/02770903.2013.816967] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Older adults with asthma can develop symptoms early in life or during adulthood. Differences between these groups may have diagnostic and therapeutic implications. Our goal was to identify differences in demographics, control, quality of life and healthcare utilization between those with long-standing asthma (LSA) and late-onset asthma (LOA). METHODS Data from a cross-sectional study of asthma patients over age 65 were analyzed. LSA or LOA was based on age of diagnosis (before or after age 40). Demographic and asthma specific information were analyzed, and allergy prick tests and lung function testing (spirometry and FENO) were performed. RESULTS After regression analysis, LSA subjects were more likely to demonstrate positive prick tests (92 versus 71%, p = 0.04), with both groups demonstrating higher levels of atopy than previously reported. LSA subjects were also more likely to have received a peak flow meter (p = 0.07). LOA subjects were more likely to have moderate or severe asthma (OR = 3.1, p = 0.05), and had higher FENO readings (p = 0.02). They also had more hospitalizations (p = 0.04), though significance was lost after regression analysis. No differences were noted in demographic information, medical comorbidities, spirometry, compliance, asthma control, or asthma quality of life between LSA and LOA subjects. CONCLUSION LSA subjects are more atopic and more likely to be given a peak flow meter, while LOA subjects have higher FENO levels and more severe asthma. Defining age of asthma onset may help improve treatment recommendations and outcomes for older adults.
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Affiliation(s)
- Alan P Baptist
- Department of Internal Medicine, Division of Allergy and Clinical Immunology , and
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Abstract
Many home-based and leisure activities can generate hazardous respirable exposures. Routine domestic activities and a variety of hobbies, avocations, and leisure pursuits have been associated with a spectrum of respiratory tract disorders. Indoor environments present a special risk for high-intensity exposures and adverse health effects. There are important knowledge gaps regarding the prevalence of specific health hazards within and across communities, exposure-response effects, population and individual susceptibilities, best management strategies, the adverse health effects of mixed exposures, and long-term clinical outcomes following exposures. The home environment presents special health risks that should be part of the health assessment.
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Affiliation(s)
- Lawrence A Ho
- Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Division of Pulmonary and Critical Care Medicine, 3801 Miranda Avenue, MC 111P, Palo Alto, CA 94304, USA.
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Busse PJ, Cohn RD, Salo PM, Zeldin DC. Characteristics of allergic sensitization among asthmatic adults older than 55 years: results from the National Health and Nutrition Examination Survey, 2005-2006. Ann Allergy Asthma Immunol 2013; 110:247-52. [PMID: 23535087 DOI: 10.1016/j.anai.2013.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/14/2013] [Accepted: 01/22/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Approximately 60% to 80% of children and young adults with asthma are sensitized to at least one allergen. In contrast, previous studies from specific subpopulations of older patients with asthma suggest that allergic sensitization is significantly lower in this age group. The prevalence and patterns of IgE-mediated sensitization have not been compared among a broad population of younger and older patients with asthma. OBJECTIVE To determine the prevalence and patterns of IgE-mediated sensitization among a broad population of younger and older patients with asthma. METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 to compare IgE-mediated sensitization rates between younger (20-40 years) and older (≥55 years) patients with current asthma. Atopy was defined as a detectable serum IgE to at least 1 allergen in a panel of 19 allergens. The associations among sensitization, current asthma, and asthma control measures (health care use and symptoms) were examined by logistic regression. RESULTS In a group of 2,573 patients, either 20 to 40 years of age or 55 years or older, 108 (6.7%) and 43 (4.5%) patients with current asthma were identified, respectively. Allergic sensitization rates among the adults with asthma differed only moderately and not statistically significantly between the age groups; 75.4% of the younger and 65.2% of the older asthmatic patients were sensitized to at least 1 allergen. The association between sensitization and markers of asthma control did not appear to differ among the age groups. CONCLUSION Allergic sensitization in older patients with asthma may be more common than previously reported.
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Affiliation(s)
- Paula J Busse
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Birmingham JM, Patil S, Li XM, Busse PJ. The effect of oral tolerance on the allergic airway response in younger and aged mice. J Asthma 2013; 50:122-32. [PMID: 23298269 DOI: 10.3109/02770903.2012.753455] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effect of increased age on the induction of oral tolerance by low-dose antigen feeding and its effect on the response to antigen airway challenge in aged mice have not been well characterized. OBJECTIVE To determine whether oral tolerance can be induced in aged mice and its impact on the development of allergic airway inflammation. METHODS Younger (6 weeks old) and aged (18 months old) mice were fed ovalbumin (OVA) prior to sensitization to induce antigen tolerance. Serum antigen-specific immunoglobulins (Igs), bronchoalveolar lavage fluid (BALF), lung histology, enumeration of CD4 + Foxp3+ Treg cells, and airway hyperresponsiveness (AHR) were determined after the final antigen challenge. RESULTS Feeding antigen to aged mice prior to sensitization induced oral tolerance as determined by a decrease in antigen-specific IgE and IgG(1); however, the effect was greater in younger mice. Induction of oral tolerance was associated with a greater increase in airway Treg cells in the younger mice. Despite these differences, oral tolerance significantly suppressed features of asthma in aged mice, including BALF total cell and eosinophil numbers, cytokine production, and AHR. CONCLUSIONS Aged mice developed oral tolerance to antigen, which suppressed several features of allergic airway inflammation.
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Affiliation(s)
- Janette M Birmingham
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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Abstract
Asthma in the adult patient is a complex clinical syndrome. Multiple patient phenotypes and subphenotypes exist that contribute to disease heterogeneity. Whether adult asthma begins in utero, develops in childhood, or manifests for the first time in adulthood is not completely understood, nor are the mechanisms fully delineated. In this chapter, we update definitions that apply to this group, emphasize epidemiologic factors and pathogenic mechanisms, diagnosis, therapeutic options, and controversies regarding drug safety. Finally, we provide a brief discussion of biomarker technologies and novel therapies with the potential to impact adult-onset asthma outcomes.
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Affiliation(s)
- Amir A Zeki
- UC Davis School of Medicine, Davis, CA, USA.
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Al-kalemji A, Petersen KD, Sørensen J, Sherson D, Thilsing T, Schlünssen V, Omland Ø, Thomsen G, Bælum J. Factors influencing quality of life in asthmatics--a case-control study. CLINICAL RESPIRATORY JOURNAL 2012; 7:288-96. [PMID: 23013421 DOI: 10.1111/crj.12006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/23/2012] [Accepted: 09/22/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The quality of life (QOL) in persons with asthma is reduced and different factors such as demography, asthma severity and psychiatric comorbidity play an influential role. However, little is known about the interplay of these factors. OBJECTIVE To describe QOL in relation to asthma and analyse for the relative impact of asthma severity, psychiatric comorbidity, lifestyle (smoking and obesity) and demographic determinants on QOL in persons with asthma. METHODS One thousand one hundred sixty-one subjects from an earlier cohort with and without asthma were sent an asthma screening questionnaire and a generic QOL measuring instrument (15D). RESULTS Seven hundred seventy-eight valid responses (67%). QOL was significantly reduced in persons with asthma compared with controls (P = 0.001), almost on all domains of 15D. In the adjusted regression model, asthma severity, depression, female gender and smoking were associated with reduced QOL, suggesting that these factors play an independent role on lowering QOL. Depression did not inflate the relationship between asthma severity and worse QOL, suggesting that asthma severity plays an independent role on everyday life regardless of psychological state. CONCLUSION Asthma severity, psychiatric comorbidity, female gender and smoking were identified in this study to be major contributors to decreased QOL in asthmatics. Health professionals should be aware of this complex picture and take these factors into consideration when choosing the proper treatment of asthma patients. Asthma, asthma severity, epidemiology, psychiatric comorbidity, QOL.
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Affiliation(s)
- Abir Al-kalemji
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark.
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Tsai CL, Lee WY, Hanania NA, Camargo CA. Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008. J Allergy Clin Immunol 2012; 129:1252-1258.e1. [DOI: 10.1016/j.jaci.2012.01.061] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/23/2012] [Accepted: 01/27/2012] [Indexed: 11/16/2022]
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Ventura MT, Gelardi M, D'Amato A, Buquicchio R, Tummolo R, Misciagna G, Canonica GW, Passalacqua G. Clinical and cytologic characteristics of allergic rhinitis in elderly patients. Ann Allergy Asthma Immunol 2012; 108:141-4. [PMID: 22374194 DOI: 10.1016/j.anai.2012.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/10/2012] [Accepted: 01/16/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The constant increase in the elderly population worldwide has led to a greater interest in immunologic responses during aging. Thus, special attention to allergic diseases in elderly people has begun to emerge, but little is known about the effect and features of allergic rhinitis in elderly people. OBJECTIVE To evaluate the clinical and cytologic characteristics of respiratory allergy and its impact on the quality of life in elderly people. METHODS Elderly patients with rhinitis referred to our allergy unit during a 3-month period underwent clinical evaluation and responded to the Rhinasthma Questionnaire. All patients also underwent skin prick testing, measurement of total IgE level, and nasal cytologic analysis. The data were compared with a control group of young adults. RESULTS Fifty-four patients older than 65 years (mean age, 69.3 years) and 89 young adults (mean age, 26.3 years) with allergic rhinitis were studied. The elderly patients had a less positive family history of atopy (P=.02) and had rhinitis plus conjunctivitis more frequently (P=.002) than young adults, whereas the difference between groups in total IgE level was not statistically significant. On nasal cytologic analysis, the differential count of inflammatory cells did not differ between groups, but in the elderly patients the epithelial-goblet cell ratio was decreased. The quality of life in elderly people was more impaired than in young adults (P=.01). CONCLUSION In elderly people with allergic rhinitis, the clinical characteristics are different and quality of life is more heavily impaired compared with young adults.
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Affiliation(s)
- Maria Teresa Ventura
- Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari, Bari, Italy
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Hwang EK, Jin HJ, Nam YH, Shin YS, Ye YM, Nahm DH, Park HS. The predictors of poorly controlled asthma in elderly. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:270-6. [PMID: 22950032 PMCID: PMC3423600 DOI: 10.4168/aair.2012.4.5.270] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/23/2011] [Accepted: 01/05/2012] [Indexed: 11/27/2022]
Abstract
Purpose To evaluate asthma control in elderly individuals and identify the factors that predict poor control. Methods A retrospective, observational study evaluating 108 elderly individuals with asthma (59 females: ≥60 years, mean age: 70.5 years) was conducted at Ajou University Hospital from October 2010 to March 2011. Subjects were classified into two groups according to scores on the asthma control test (ACT). Group I consisted of 38 patients with ACT scores ≤19 (poor controllers) and group II included 70 patients with ACT scores >19 (controllers). Clinical data was analyzed. Spirometry was performed, and the ACT and asthma quality-of-life survey were completed. Medication possession ratios were calculated to evaluate compliance. Results Of the 108 enrolled subjects, 54.6% were female, 7.5% were obese, and 49.0% were atopic. The mean age of the patients was 70.5, and the average of time patients had suffered from asthma was 15.5 years. Comorbid conditions were found in more than 80% of the patients. Allergic rhinitis was most common comorbid condition; this was followed by cardiovascular disease and degenerative arthritis (76.9%, 65.7%, and 51.9%, respectively). Many patients (35.2%) were in poorly controlled states characterized by significantly lower asthma quality of life scores (P<0.001) and higher admission rates (P=0.034). Multivariate logistic regression analysis showed that a history of pulmonary tuberculosis was a predictor of poorly controlled asthma in elderly individuals even after adjusting for age, sex, smoking, lung function and other comorbidities (OR=4.70, CI=1.06-20.81, P=0.042). Conclusions The asthma of more than one-third of elderly individuals with this condition was poorly controlled, and a history of pulmonary tuberculosis may have contributed to this outcome. Proper evaluation and management of comorbid conditions in elderly patients with asthma is essential for the achievement of better control of the disease and a higher quality of life for those who suffer from it.
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Affiliation(s)
- Eui-Kyung Hwang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Smith AM, Villareal M, Bernstein DI, Swikert DJ. Asthma in the elderly: risk factors and impact on physical function. Ann Allergy Asthma Immunol 2012; 108:305-10. [PMID: 22541399 DOI: 10.1016/j.anai.2012.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/23/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The incidence rate of asthma has increased in all age groups in the past 40 years. Asthma in older adults is underdiagnosed and undertreated, resulting in suboptimal asthma control. OBJECTIVE The objectives of the study are to evaluate differences in host characteristics between older patients with asthma and persons who do not have asthma and how these differences impact overall quality of life. METHODS Patients older than age 60 years were recruited from the general population for this case/control and nested cohort study. A complete medical history, physical examination, skin prick testing (SPT), spirometry, and exhaled nitric oxide (ENO) measurements were performed. Quality of life was assessed through the standardized SF-36v2 questionnaire. Quality of life scores, spirometry, ENO, and aeroallergen sensitization differences were compared between older patients with asthma and control patients. RESULTS The mean age of the 77 patients evaluated was 68.7 ± 7.2 years, with 59 (77%) being female. A higher rate of SPT positivity was found in patients with asthma (88.9%) compared with controls (51.2%) (P = .007). The mean percent predicted forced expiratory volume in 1 second (FEV1) at baseline was lower in the asthma group (73.7 ± 21.9%) compared with controls (89.6 ± 19.1%) (P = .007). For quality of life assessed by the SF-36v2 questionnaire, the asthma group had worse general health, increased bodily pain, and worse overall physical health compared with controls (P = .02; .021; .01). CONCLUSION Older adults with asthma have a higher rate of allergic sensitization, decreased lung function, and significantly worse quality of life compared with controls.
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Affiliation(s)
- Andrew M Smith
- University of Cincinnati Medical Center,Division of Immunology, 231 Albert Sabin Way, Cincinnati, OH 45267-0563, USA.
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Todo-Bom A, Mota-Pinto A, Alves V, Santos-Rosa M. Aging and asthma - changes in CD45RA, CD29 and CD95 T cells subsets. Allergol Immunopathol (Madr) 2012; 40:14-9. [PMID: 21507549 DOI: 10.1016/j.aller.2011.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/11/2011] [Accepted: 01/18/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aging is associated with thymus involution leading to a reduction in naive T cells and to an accumulation of effector-memory cells. Apoptosis is a key mechanism to clear the immune system from activated and harmful cells. In asthma the stimulation of T cells by environmental antigens can decrease naive cells and sustain activated cells. The aim of this work was to evaluate the imbalance between CD45RA and CD29 cells during the aging process and their changes in elderly asthma and to evaluate how elderly and chronic diseases like asthma can affect susceptibility to apoptosis. METHODS Elderly and young adult healthy volunteers and elderly asthmatic patients were submitted to skin prick tests, immunoglobulin determination and flow cytometry analyses of CD3, CD4, CD8, CD45RA, CD29, and CD95. RESULTS Serum IgE was increased in allergic patients (p=0.0001). Asthmatics presented an increase in CD4 cells (p<0.05). CD45RA was significantly decreased in elderly individuals (p<0.05) and this decrease was higher in asthmatics (p<0.05). CD29 was increased in elderly healthy individuals compared to the control young group (p=0.0001). A negative correlation between CD29 and CD45RA (p<0.05) was observed. CD95 lymphocytes increased in elderly (p=0.0001) and a positive correlation between age and CD95 (p<0.05) was found. Asthmatic patients showed significant decreases in CD95 (p=0. 0001). CONCLUSIONS Naive cells are key cells in the defence against infections and their decrease in the elderly and in asthma is a bad prognosis factor. The reduction of apoptosis markers can promote the persistence of activated cells involved in chronic conditions.
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Viswanathan RK, Mathur SK. Role of allergen sensitization in older adults. Curr Allergy Asthma Rep 2011; 11:427-33. [PMID: 21667198 DOI: 10.1007/s11882-011-0204-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is a common perception among physicians and patients that allergic diseases are not relevant in older adults. There is also recognition that innate and adaptive immune functions decline with aging. It is the function of a variety of immune cells in the form of allergic inflammation that is a hallmark of allergic diseases. In fact, there is a fairly consistent observation that measures of allergic sensitization, such as skin prick testing, specific IgE, or total IgE, decline with age. Nonetheless, the association between allergic sensitization and allergic diseases, particularly asthma and allergic rhinitis, remains robust in the older adult population. Consequently, an appropriate evaluation of allergic sensitivities is warranted and indicated in older asthma and rhinitis patients to provide optimal care for the individual and minimize any resultant morbidity and mortality.
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Affiliation(s)
- Ravi K Viswanathan
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, K4/952 CSC, 600 Highland Avenue, Madison, WI 53792, USA
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