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Zarate-Gonzalez G, Brown P, Cisneros R. Costs of Air Pollution in California's San Joaquin Valley: A Societal Perspective of the Burden of Asthma on Emergency Departments and Inpatient Care. J Asthma Allergy 2024; 17:369-382. [PMID: 38645669 PMCID: PMC11032670 DOI: 10.2147/jaa.s455745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The San Joaquin Valley (SJV) is often recognized as one of the most polluted regions in the US. Periods of pollution exposure are associated with increased health burden related to respiratory inflammation and undermined lung function, which aggravates respiratory diseases such as asthma and leads to symptoms such as coughing, wheezing, or difficulty breathing. Asthma costs US$ 82 billion annually in healthcare costs, missed work and school in the US. Methods Employing a societal perspective, a cost of illness design was combined with environmental epidemiological methods to analyze the economic impact of O3, NO2, and PM2.5-related adverse respiratory health outcomes amongst SJV residents who attended the emergency department (ED) or were hospitalized in 2016. Results Asthma exacerbations monetized value ranged from US$ 3353 to US$ 5003 per ED visit and for hospital admissions US$ 2584 per inpatient day for adults 65 years and older to US$ 3023 per child. The estimated value to society in healthcare costs, productivity losses, school absences, and opportunity costs from air pollution adverse health outcomes totaled US$ 498,014,124 in ED visits and US$ 223,552,720 in hospital admissions for the SJV population in 2016. The marginal reduction in the background concentrations of pollutants would avert 21,786 ED adverse events and 19,328 hospitalizations from the health burden on the SJV population or US$ 8,024,505 cost savings due to O3, US$ 82,482,683 from NO2 reductions, and US$ 46,214,702 from decreased concentration of PM2.5. Conclusion This study provides evidence that air pollution is a negative externality that imposes substantial social, environmental, and healthcare costs on the SJV. Furthermore, the region would avert significant adverse health outcomes realizing economic savings by reducing air pollution and exposures.
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Affiliation(s)
| | - Paul Brown
- Department of Public Health, University of California, Merced, CA, USA
| | - Ricardo Cisneros
- Department of Public Health, University of California, Merced, CA, USA
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2
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Park HW, Cho SH. Management of Elderly Asthma: Key Questions and Tentative Answers. Allergy Asthma Immunol Res 2023; 15:8-18. [PMID: 36693354 PMCID: PMC9880298 DOI: 10.4168/aair.2023.15.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
The aging lung undergoes structural changes, immunosenescence, and inflammation, rendering the elderly more susceptible to developing obstructive airway disease. Thus, asthma in those of chronological age ≥ 65 years is not rare. Elderly asthma (EA) imposes considerable burdens in terms of mortality and morbidity, and expenditure. However, clinicians lack knowledge of EA and thus often prescribe inappropriate management. In this review, we ask 3 key questions frequently encountered during EA diagnosis and treatment: 1) Is EA different?; 2) How can we appropriately diagnose EA?; 3) Are there management strategies specific to EA? Based on recent studies, we provide tentative answers as follows: 1) late-onset EA differs in clinical features and pathogenetic mechanisms from non-EA, and thus further phenotypic and endotypic characterization of EA is needed; 2) both over- and under-diagnosis of asthma in the elderly can be reduced if the objective diagnostic tests are appropriately performed; 3) cautious prescription of ICS to selected EA patients should be encouraged, and a multifaceted approach which involves increasing medical awareness and inhaler use proficiency and adherence, seeking the assistance of caregivers, and correcting micronutrient deficiencies is required to reduce acute exacerbations in EA patients.
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Affiliation(s)
- Heung-Woo Park
- Divison of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Heon Cho
- Divison of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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3
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Farooq S, Khatri S. Life Course of Asthma. Adv Exp Med Biol 2023; 1426:43-76. [PMID: 37464116 DOI: 10.1007/978-3-031-32259-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma is a heterogeneous chronic airway disease that can vary over a lifetime. Although broad categories of asthma by severity and type have been constructed, there remains a tremendous opportunity to discover an approach to managing asthma with additional factors in mind. Many in the field have suggested and are pursuing a novel paradigm shift in how asthma might be better managed, considering the life course of exposures, management priorities, and predicted trajectory of lung function growth. This approach will require a more holistic view of prenatal, postnatal, adolescence, hormonal and gender aspects, and the aging process. In addition, the environment, externally and internally, including in one's genetic code and epigenetic changes, are factors that affect how asthma progresses or becomes more stable in individuals. This chapter focuses on the various influences that may, to differing degrees, affect people with asthma, which can develop at any time in their lives. Shifting the paradigm of thought and strategies for care and advocating for public policies and health delivery that focus on this philosophy is paramount to advance asthma care for all.
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Affiliation(s)
- Sobia Farooq
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA
| | - Sumita Khatri
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA.
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4
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Ait-hadad W, Bédard A, Delvert R, Orsi L, Chanoine S, Dumas O, Laouali N, Le Moual N, Leynaert B, Siroux V, Boutron-Ruault MC, Varraso R. Plant-Based Diets and the Incidence of Asthma Symptoms among Elderly Women, and the Mediating Role of Body Mass Index. Nutrients 2022; 15:nu15010052. [PMID: 36615710 PMCID: PMC9824479 DOI: 10.3390/nu15010052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
We aimed to test the hypothesis that adherence to a healthful plant-based diet (hPDI) is associated with a subsequent decrease in the incidence of asthma symptoms, with an opposite association with adherence to an unhealthful plant-based diet (uPDI). In addition, we evaluated a potential mediating role of body mass index (BMI) and the modifying effect of smoking. Among 5700 elderly women from the French Asthma-E3N study with dietary data in 1993 and 2005, we assessed the incidence of asthma symptoms in 2018 among women with no asthma symptoms in 2011. BMI was evaluated in 2008. Mediation analyses in the counterfactual framework were used to disentangle total, direct, and indirect effects mediated by BMI. We found that both healthful and unhealthful plant-based diets were associated with a lower incidence of asthma symptoms over time, mediated by BMI (OR (95%CI) for the indirect effect: 0.94 (0.89-1.00) for hPDI and 0.92 (0.70-1.00) for uPDI)). Associations with both healthful and unhealthful PDIs were mediated by changes in BMI by 33% and 89%, respectively. Plant-based diets (healthful and unhealthful) were associated with subsequently reduced incidences of asthma symptoms over time, partly or almost totally mediated by BMI according to their nutritional quality.
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Affiliation(s)
- Wassila Ait-hadad
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Annabelle Bédard
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Rosalie Delvert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Sébastien Chanoine
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Nasser Laouali
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, Équipe “Exposome et Hérédité”, CESP, 94805 Villejuif, France
- Correspondence:
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, Équipe “Exposome et Hérédité”, CESP, 94805 Villejuif, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
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Ryu K, Fukutomi Y, Nakatani E, Iwata M, Nagayama K, Yano K, Nakamura Y, Hamada Y, Watai K, Kamide Y, Sekiya K, Araya J, Kuwano K, Taniguchi M. Frailty and muscle weakness in elderly patients with asthma and their association with cumulative lifetime oral corticosteroid exposure. Allergol Int 2022; 72:252-261. [PMID: 36371246 DOI: 10.1016/j.alit.2022.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome of age-related physiological decline, which is associated with higher mortality and decreased healthy life expectancy, and muscle weakness is one of the presentations of frailty. We investigated an association between lifetime oral corticosteroid (OCS) exposure with frailty and muscle weakness among elderly patients with asthma. METHODS We studied 203 consecutive elderly outpatients with asthma aged ≥60 years old. They were classified into three groups according to their cumulative lifetime OCS dose (lifetime non-users, lower-dose users, and higher-dose users), which was retrospectively estimated from the response to a structured questionnaire. The prevalence of frailty determined by the Kihon Checklist was compared between the three groups. Hand-grip strength, and lean mass index were also measured as markers of muscle strength. RESULTS Thirty-seven percent of the patients studied were considered frail. Higher cumulative lifetime OCS exposure was associated with a significantly higher prevalence of frailty (33% in lifetime non-users, 59% in lower-dose users, and 68% in higher-dose users; P for trend <0.005). This was also associated with lower hand-grip strength in both sexes (P for trend; 0.012 in men, and 0.020 in women), and lower lean mass index in men (P for trend 0.002). However, current doses of OCS were not significantly associated with these outcomes. CONCLUSIONS Cumulative lifetime OCS exposure was associated with a higher prevalence of frailty and muscle weakness. These findings emphasize the importance of minimizing lifetime OCS exposure for the prolongation of healthy life expectancy in patients with asthma.
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Affiliation(s)
- Kai Ryu
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan; Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Maki Iwata
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Kisako Nagayama
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Koichi Yano
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Yuto Nakamura
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Yuto Hamada
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Kentaro Watai
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan; Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yosuke Kamide
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Kiyoshi Sekiya
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan; Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan.
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6
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Soriano JB. Planetary respiratory health for asthma, rhinoconjunctivitis and eczema. Eur Respir J 2022; 60:60/3/2200440. [PMID: 36109045 DOI: 10.1183/13993003.00440-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Joan B Soriano
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain .,Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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7
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Perpiñá M, Gómez-Bastero A, Trisán A, Martínez-Moragón E, Álvarez-Gutiérrez FJ, Urrutia I, Blanco-Aparicio M. Expert consensus recommendations for the management of asthma in older adults. Med Clin (Barc) 2022; 159:53.e1-53.e14. [PMID: 34226059 DOI: 10.1016/j.medcli.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.
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Affiliation(s)
- Miguel Perpiñá
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Andrea Trisán
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - Isabel Urrutia
- Unidad de Asma y Enfermedades Ocupacionales-Medioambientales, Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, España
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8
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Zhu Y, Yang T, Huang S, Li H, Lei J, Xue X, Gao Y, Jiang Y, Liu C, Kan H, Chen R. Cold temperature and sudden temperature drop as novel risk factors of asthma exacerbation: a longitudinal study in 18 Chinese cities. Sci Total Environ 2022; 814:151959. [PMID: 34843761 DOI: 10.1016/j.scitotenv.2021.151959] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/31/2021] [Accepted: 11/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Few studies have explored the role of ambient temperature in asthma exacerbation. OBJECTIVE We aimed to explore the association of temperature with diurnal peak expiratory flow (PEF) variation and asthma exacerbation. METHOD We developed a longitudinal study among asthmatic adults in 18 Chinese cities. Subjects recorded PEF in dynamic pulmonary function monitoring from 2017 to 2020. Linear mixed-effect model and generalized additive model with distributed non-linear models were used to assess the effect of temperature and temperature change between neighboring days (TCN) on diurnal PEF variation and the risk of asthma exacerbation. RESULT We evaluated a total of 79,217 daily PEF monitoring records from 4467 adult asthmatic patients. There were significant increase of diurnal PEF variation and higher risk of asthma exacerbation with cold and sudden temperature drop. Compared with the referent temperature (99th percentile, 32 °C), exposure to moderate cold (25th percentile, 3 °C) and extreme cold (2.5th percentile, -7 °C) was associated with elevations of 1.28% and 1.16% in diurnal PEF variation over lag 0-2 days, respectively. The odds ratios of asthma exacerbation (determined by diurnal PEF variation >20%) at the two temperature cutoffs were 1.68 and 1.73. A sudden temperature drop (2.5th percentile of TCN, -5 °C) was associated with 1.13% elevation in diurnal PEF variation, and with increased risk of asthma exacerbation (odd ratio = 1.50) over lag 0-4 days. CONCLUSION This large multicenter study provided the first-hand empirical evidence that cold temperature and a temperature drop may increase the risk of asthma exacerbation.
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Affiliation(s)
- Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine and National Center for Respiratory Medicine & National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Suijie Huang
- Guangzhou Homesun Medical Technology Co.,Ltd, Guangdong Province, China
| | - Huichu Li
- Department of Environmental Health, Harvard T.H.Chan School of Public Health, Boston, MA, USA
| | - Jian Lei
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xiaowei Xue
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Ya Gao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yixuan Jiang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai 200030, China.
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9
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Ait-hadad W, Bédard A, Chanoine S, Dumas O, Laouali N, Le Moual N, Leynaert B, Macdonald C, Siroux V, Boutron-Ruault MC, Varraso R. Healthy diet associated with better asthma outcomes in elderly women of the French Asthma-E3N study. Eur J Nutr 2022; 61:2555-2569. [PMID: 35220443 PMCID: PMC9279211 DOI: 10.1007/s00394-022-02815-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose The impact of a healthy diet on asthma prevention and management, particularly among elderly women, remains poorly understood. We investigated whether a healthy diet would be associated with fewer asthma symptoms, and, among women with asthma, with reduced uncontrolled asthma and metabolic-related multimorbidity. Methods We included 12,991 elderly women (mean age = 63 years) from the Asthma-E3N study, a nested case–control study within the French E3N cohort. Negative binomial regressions were used to analyse associations between a healthy diet [evaluated by the Alternate Healthy Eating Index-2010 (AHEI-2010)] and a validated asthma symptom score, and logistic regressions to analyse associations between the AHEI-2010 with the asthma control test and multimorbidity profiles previously identified by clustering methods on medications used. Results After adjustment for potential confounders, a linear inverse association was found between the AHEI-2010 score and the asthma symptom score [mean score ratio (95% CI) = 0.82 (0.75–0.90) for the highest versus lowest quintile; p for trend < 0.0001]. In addition, women in the highest versus lowest AHEI-2010 tertile were at a lower risk to belong to the “Predominantly metabolic multimorbidity-related medications profile” compared to the “Few multimorbidity-related medications" profile [OR 0.80 (0.63–1.00) for tertile 3; p for trend = 0.05; n = 3474]. Conclusion Our results show that a healthy dietary intake could play an important role in the prevention and management of asthma over the life course. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-022-02815-0.
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10
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Saheb Sharif-Askari F, Goel S, Saheb Sharif-Askari N, Hafezi S, Al Heialy S, Hachim MY, Hachim IY, Mahboub B, Salameh L, Abdelrazig M, Elzain EI, Al-Muhsen S, Al-Hajjaj MS, Ratemi E, Hamid Q, Halwani R. Asthma Associated Cytokines Regulate the Expression of SARS-CoV-2 Receptor ACE2 in the Lung Tissue of Asthmatic Patients. Front Immunol 2022; 12:796094. [PMID: 35111161 PMCID: PMC8801531 DOI: 10.3389/fimmu.2021.796094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 01/10/2023] Open
Abstract
It is still controversial whether chronic lung inflammation increases the risk for COVID-19. One of the risk factors for acquiring COVID-19 is the level of expression of SARS-CoV-2 entry receptors, ACE2 and TMPRSS2, in lung tissue. It is, however, not clear how lung tissue inflammation affects expression levels of these receptors. We hence aimed to determine the level of SARS-CoV-2 receptors in lung tissue of asthmatic relative to age, gender, and asthma severity, and to investigate the factors regulating that. Therefore, gene expression data sets of well-known asthmatic cohorts (SARP and U-BIOPRED) were used to evaluate the association of ACE2 and TMPRSS2 with age, gender of the asthmatic patients, and also the type of the underlying lung tissue inflammatory cytokines. Notably, ACE2 and to less extent TMPRSS2 expression were upregulated in the lung tissue of asthmatics compared to healthy controls. Although a differential expression of ACE2, but not TMPRSS2 was observed relative to age within the moderate and severe asthma groups, our data suggest that age may not be a key regulatory factor of its expression. The type of tissue inflammation, however, associated significantly with ACE2 and TMPRSS2 expression levels following adjusting with age, gender and oral corticosteroids use of the patient. Type I cytokine (IFN-γ), IL-8, and IL-19 were associated with increased expression, while Type II cytokines (IL-4 and IL-13) with lower expression of ACE2 in lung tissue (airway epithelium and/or lung biopsies) of moderate and severe asthmatic patients. Of note, IL-19 was associated with ACE2 expression while IL-17 was associated with TMPRSS2 expression in sputum of asthmatic subjects. In vitro treatment of bronchial fibroblasts with IL-17 and IL-19 cytokines confirmed the regulatory effect of these cytokines on SARS-CoV-2 entry receptors. Our results suggest that the type of inflammation may regulate ACE2 and TMPRSS2 expression in the lung tissue of asthmatics and may hence affect susceptibility to SARS-CoV-2 infection.
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Affiliation(s)
- Fatemeh Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Swati Goel
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Narjes Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Shirin Hafezi
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Saba Al Heialy
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Meakins-Christie Laboratories, McGill University, Montreal, QC, Canada
| | - Mahmood Yaseen Hachim
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ibrahim Yaseen Hachim
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Bassam Mahboub
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Laila Salameh
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Mawada Abdelrazig
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Saleh Al-Muhsen
- Immunology Research Lab, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed S Al-Hajjaj
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Elaref Ratemi
- Jubail-Industrial College, Department of Chemical and Process Engineering Technology, Jubail-Industrial City, Saudi Arabia
| | - Qutayba Hamid
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Meakins-Christie Laboratories, McGill University, Montreal, QC, Canada.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Prince Abdullah Ben Khaled Celiac Disease Chair, department of pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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11
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MAHDAVIAZAD HAMIDEH, SHAHROKHI SHERVINDOKHT, MASOOMPUR SEYEDMASOOM. Socioeconomic-related determinants of asthma in the elderly. J Prev Med Hyg 2021; 61:E578-E583. [PMID: 33628964 PMCID: PMC7888395 DOI: 10.15167/2421-4248/jpmh2020.61.4.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022]
Abstract
Introduction As the population ages, the impact of asthma in the elderly is expected to be enhanced over the forthcoming decades. We investigated the prevalence of asthma and its socioeconomic factors in the elderly, Shiraz, Iran. Methods In this population-based study, 1527 subjects older than 60 years were selected based on the stratified random sampling method. The data on asthma symptoms, current asthma, physician diagnose asthma, and allergic rhinitis were collected using the translated ECRHS (European Community Respiratory Health Survey) questionnaire. Information on individual socioeconomic status was derived from the participants' self-reported educational level and their occupation, income, and residence. A p-value of less than 0.05 was considered to be statistically significant. Results The prevalence of asthma, current asthma, physician diagnose asthma, and allergic rhinitis was found to be 8.97, 6.81, 4.78 and, 23.51%, respectively. The most common asthma symptoms were nocturnal chest tightness (15.52%, n = 237/1,527). In univariate analysis, the prevalence of asthma was higher in illiterate patients (12.7%), subjects with the lowest income level (10.6%), and patients living in urban areas (24.1%). Having age more than 80 (OR = 2.01; 95% CI = 1.10-3.65), being a current smoker (OR = 2.76; 95% CI = 1.69-4.51) and living in a suburban area (OR = 3.01; 95% CI = 1.20-7.50) were significant predictive factors for asthma in the regression model. Conclusions Asthma and allergic rhinitis in the elderly should be more focus in the southwest of Iran. Moreover, our findings highlighted the effect of socio- economic status, disparities and inequality on community health.
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Affiliation(s)
- HAMIDEH MAHDAVIAZAD
- Department of Family Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - SEYED MASOOM MASOOMPUR
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Seyed Masoom Masoompur, Shiraz University of Medical Sciences 6 floor, Administration Building Zand St., Shiraz, Iran - E-mail:
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12
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Weckmann M, Thiele D, Liboschik L, Bahmer T, Pech M, Dittrich AM, Fuchs O, Happle C, Schaub B, Ricklefs I, Rabe KF, von Mutius E, Hansen G, König IR, Kopp MV. Cytokine levels in children and adults with wheezing and asthma show specific patterns of variability over time. Clin Exp Immunol 2020; 204:152-164. [PMID: 33202033 DOI: 10.1111/cei.13550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Levels of cytokines are used for in-depth characterization of patients with asthma; however, the variability over time might be a critical confounder. To analyze the course of serum cytokines in children, adolescents and adults with asthma and in healthy controls and to propose statistical methods to control for seasonal effects. Of 532 screened subjects, 514 (91·5%) were included in the All Age Asthma Cohort (ALLIANCE). The cohort included 279 children with either recurrent wheezing bronchitis (more than two episodes) or doctor-diagnosed asthma, 75 healthy controls, 150 adult asthmatics and 31 adult healthy controls. Blood samples were collected and 25 μl serum was used for analysis with the Bio-Plex Pr human cytokine 27-Plex assay. Mean age, body mass index and gender in the three groups of wheezers, asthmatic children and adult asthmatics were comparable to healthy controls. Wheezers (34·5%), asthmatic children (78·7%) and adult asthmatics (62·8%) were significantly more often sensitized compared to controls (4·5, 22 and 22·6%, respectively). Considering the entire cohort, interleukin (IL)-1ra, IL-4, IL-9, IL-17, macrophage inflammatory protein (MIP)-1- α and tumor necrosis factor (TNF)- α showed seasonal variability, whereas IL-1β, IL-7, IL-8, IL-13, eotaxin, granulocyte colony-stimulating factor (G-CSF), interferon gamma-induced protein (IP)-10, MIP-1 β and platelet-derived growth factor (PDGF)-BB did not. Significant differences between wheezers/asthmatics and healthy controls were observed for IL-17 and PDGF-BB, which remained stable after adjustment for the seasonality of IL-17. Seasonality has a significant impact on serum cytokine levels in patients with asthma. Because endotyping has achieved clinical importance to guide individualized patient-tailored therapy, it is important to account for seasonal effects.
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Affiliation(s)
- M Weckmann
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - D Thiele
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - L Liboschik
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - T Bahmer
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Departement for Internal Medicine I, Pneumology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Pneumology, Lungen Clinic Grosshansdorf, Großhansdorf, Germany
| | - M Pech
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - A-M Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Member of the German Center of Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Lübeck, Germany
| | - O Fuchs
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Division of Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - C Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Member of the German Center of Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Lübeck, Germany
| | - B Schaub
- Department of Pediatrics, Department of Allergology, Dr von Hauner Children's Hospital University Hospital, LMU Munich, Munich, Germany.,Member of the German Center of Lung Research (DZL), Comprehensive Pneumology Center München (CPC-M), Lübeck, Germany
| | - I Ricklefs
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - K F Rabe
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Departement for Internal Medicine I, Pneumology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - E von Mutius
- Department of Pediatrics, Department of Allergology, Dr von Hauner Children's Hospital University Hospital, LMU Munich, Munich, Germany.,Member of the German Center of Lung Research (DZL), Comprehensive Pneumology Center München (CPC-M), Lübeck, Germany
| | - G Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Member of the German Center of Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Lübeck, Germany
| | - I R König
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - M V Kopp
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Division of Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
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13
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Fukuda Y, Akimoto K, Homma T, Baker JR, Ito K, Barnes PJ, Sagara H. Virus-Induced Asthma Exacerbations: SIRT1 Targeted Approach. J Clin Med 2020; 9:E2623. [PMID: 32823491 DOI: 10.3390/jcm9082623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence of asthma has increased worldwide. Asthma exacerbations triggered by upper respiratory tract viral infections remain a major clinical problem and account for hospital admissions and time lost from work. Virus-induced asthma exacerbations cause airway inflammation, resulting in worsening asthma and deterioration in the patients’ quality of life, which may require systemic corticosteroid therapy. Despite recent advances in understanding the cellular and molecular mechanisms underlying asthma exacerbations, current therapeutic modalities are inadequate for complete prevention and treatment of these episodes. The pathological role of cellular senescence, especially that involving the silent information regulator 2 homolog sirtuin (SIRT) protein family, has recently been demonstrated in stable and exacerbated chronic respiratory disease states. This review discusses the role of SIRT1 in the pathogenesis of bronchial asthma. It also discusses the role of SIRT1 in inflammatory cells that play an important role in virus-induced asthma exacerbations. Recent studies have hypothesized that SIRT1 is one of major contributors to cellular senescence. SIRT1 levels decrease in Th2 and non-Th2-related airway inflammation, indicating the role of SIRT1 in several endotypes and phenotypes of asthma. Moreover, several models have demonstrated relationships between viral infection and SIRT1. Therefore, targeting SIRT1 is a novel strategy that may be effective for treating virus-induced asthma exacerbations in the future.
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14
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Hough KP, Curtiss ML, Blain TJ, Liu RM, Trevor J, Deshane JS, Thannickal VJ. Airway Remodeling in Asthma. Front Med (Lausanne) 2020; 7:191. [PMID: 32509793 PMCID: PMC7253669 DOI: 10.3389/fmed.2020.00191] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Asthma is an inflammatory disease of the airways that may result from exposure to allergens or other environmental irritants, resulting in bronchoconstriction, wheezing, and shortness of breath. The structural changes of the airways associated with asthma, broadly referred to as airway remodeling, is a pathological feature of chronic asthma that contributes to the clinical manifestations of the disease. Airway remodeling in asthma constitutes cellular and extracellular matrix changes in the large and small airways, epithelial cell apoptosis, airway smooth muscle cell proliferation, and fibroblast activation. These pathological changes in the airway are orchestrated by crosstalk of different cell types within the airway wall and submucosa. Environmental exposures to dust, chemicals, and cigarette smoke can initiate the cascade of pro-inflammatory responses that trigger airway remodeling through paracrine signaling and mechanostimulatory cues that drive airway remodeling. In this review, we explore three integrated and dynamic processes in airway remodeling: (1) initiation by epithelial cells; (2) amplification by immune cells; and (3) mesenchymal effector functions. Furthermore, we explore the role of inflammaging in the dysregulated and persistent inflammatory response that perpetuates airway remodeling in elderly asthmatics.
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Affiliation(s)
- Kenneth P Hough
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Miranda L Curtiss
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Trevor J Blain
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rui-Ming Liu
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer Trevor
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessy S Deshane
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Victor J Thannickal
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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15
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Jeong JW, Lim KH, Lee WH, Won JY, Kwon JW. Heterogeneity of Adult Rhinitis for Multimorbidity and Age at Onset among Non-Sensitized Rhinitis and Mono-/Poly-Sensitized Rhinitis: A Retrospective Cross-Sectional Study. Int Arch Allergy Immunol 2020; 181:512-521. [PMID: 32434186 DOI: 10.1159/000507444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent studies have proposed that clinical and immunological differences exist between mono- and poly-sensitized subjects with allergic diseases, and poly-sensitization was related to multimorbidity of allergic diseases among children and adolescents. OBJECTIVE We compared the clinical characteristics and multimorbidity of allergic diseases between adult rhinitis patients mono- and poly-sensitized to common aeroallergens using a retrospective cross-sectional study for tertiary care subjects. METHODS The medical records of 1,615 patients who were clinically diagnosed with rhinitis by an otolaryngologist and evaluated with skin prick tests were reviewed. The severity of the rhinitis symptoms, comorbidities (asthma, conjunctivitis, and eczema), family history of allergic diseases, and the results of skin prick tests were evaluated. RESULTS There were 392 patients with mono-sensitized rhinitis (mono-sR), 325 with poly-sensitized rhinitis (poly-sR), and 898 with non-sensitized rhinitis (non-sR). Comorbid conjunctivitis and eczema were most common in poly-sR, followed by mono-sR, and least common in non-sR patients. The age at onset of rhinitis was clearly different between adult patients with non-sR and mono-/poly-sR, but not between patients with mono-sR and poly-sR. However, the age at onset of rhinitis was much younger in non-sR and mono-sR patients with conjunctivitis or eczema than those without such comorbidities. CONCLUSION Thefrequency of comorbid conjunctivitis and eczema in adult rhinitis patients differed by a quantitative trait of immunoglobulin E sensitization. Depending on the multimorbidity of allergic diseases, onset age of rhinitis seems to be different in adult rhinitis patients.
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Affiliation(s)
- Jae Won Jeong
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Republic of Korea
| | - Kyu-Hyoung Lim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Woo Hyun Lee
- Department of Otolaryngology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jun Yeon Won
- Department of Otolaryngology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea,
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16
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Soma T, Uchida Y, Hoshino Y, Katayama K, Kobayashi T, Nakagome K, Nagata M. Relationship between airway inflammation and airflow limitation in elderly asthmatics. Asia Pac Allergy 2020; 10:e17. [PMID: 32411582 PMCID: PMC7203439 DOI: 10.5415/apallergy.2020.10.e17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background The prevalence of asthma in elderly population has been increasing. Previous studies have demonstrated clinical characteristics of elderly asthmatics (EA). However, little is known regarding the influence of immunological change on the physiological status of EA. Objective We investigated the relationship between inflammatory mediators and the pulmonary function (PF) of EA. Methods Eligible adult asthmatics recruited from the Allergy Center of Saitama Medical University Hospital were classified into a non-EA group (<40 years old, n = 15) and an EA group (≥60 years old, n = 43). Sputum induction and PF tests were performed. Concentrations of an eosinophil-derived neurotoxin (EDN) and neutrophil elastase (NE) in sputum supernatants were measured by enzyme-linked immunosorbent assay and a fluorometric assay using a commercial assay kit, respectively. Cell counts and EDN and NE concentrations in sputum were compared between the 2 groups. The association among those parameters and PF were analyzed in each group. Results The EA group had a significantly higher severe asthmatics proportion (p = 0.01), a lower current smokers proportion (p = 0.002), lower sensitization rate to aeroallergens (p = 0.012), several PFs deterioration (p < 0.0001) and lower total IgE levels (p = 0.001) than the non-EA group. Sputum neutrophil counts and NE concentrations were significantly higher in the EA group than those in the non-EA group (median neutrophil: 4.11 vs. 2.74 ×105/mL, p = 0.03; NE: 2.0 vs.1.6 µg/mL, p < 0.05, respectively), whereas sputum eosinophil counts and EDN concentrations were not. Sputum EDN concentrations were significantly positively correlated with sputum neutrophil counts (r = 0.39, p = 0.031) and NE concentrations (r = 0.57, p < 0.0001) only in the EA group. Eosinophil-related parameters were negatively correlated with several PFs in the 2 groups. Neutrophil-related parameters were negatively correlated with PFs only in the non-EA group. Conclusion This study determines that in EA, persistent active eosinophilic airway inflammation is accompanied by advanced neutrophilic inflammation, which may contribute to deteriorated PF. This distinct airway inflammation may increase the severity of asthma in EA.
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Affiliation(s)
- Tomoyuki Soma
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University Hospital, Saitama, Japan
| | - Yoshitaka Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University Hospital, Saitama, Japan
| | - Yuki Hoshino
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University Hospital, Saitama, Japan
| | - Kazuki Katayama
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University Hospital, Saitama, Japan
| | - Takehito Kobayashi
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Kazuyuki Nakagome
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University Hospital, Saitama, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.,Allergy Center, Saitama Medical University Hospital, Saitama, Japan
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17
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Abstract
Abstract
In the area of the Medical Sciences, the chronological age has always been, and still is, an indicator by which we try to understand the health status of an individual. However, besides considering people born with an already expressed disease, each human genome has sequence alterations called predisposing mutations; carriers of such genetic alterations have an increased risk of contracting diseases during their life. In addition, the exposome, i.e. the totality of environmental noxae (“hits”) to which our body is exposed throughout life (through ingestion, breathing, body surface hits, and psychosociological stress agents, etc.) contributes to increase gradually but inexorably the frailty of an organism, and this process is usually referred to as “physiological ageing”. This position paper proposes that we invert our visual angle and view the passage-of-time not as the cause of diseases, but consider the genome alterations present at birth and the noxae received during our life as the real major causes of ageing. The Biomedical Sciences are now increasingly unraveling the etiopathogenesis of most chronic degenerative diseases; thus, it will be possible to monitor and treat those that most contribute to the increased frailty of each person, which is now referred to with the misnomer “physiological ageing”. These concepts are not banal; indeed, they imply that we must try to avoid the causes of alterations that result later in chronic degenerative diseases. Thus, we should shift our attention from the cure to the prevention of alterations/diseases also to improve both the length and quality of our life. Moreover, this approach involves real personalized or individualized medicine, thus conferring a more direct benefit to each of us by finalizing either the cure or the monitoring of diseases.
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Affiliation(s)
- Francesco Salvatore
- Department of Molecular Medicine and Medical Biotechnologies , University of Naples Federico II , Naples , Italy
- CEINGE Biotecnologie Avanzate Scarl , Naples , Italy
- Inter-University Center for Multifactorial and Multigenes Chronic Human Diseases, Federico II Naples, Tor Vergata Roma2, Chieti-Pescara Universities , Naples , Italy
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18
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Abstract
Objective: Bilastine is a potent and highly selective H1-antihistamine approved for the treatment of allergic rhinoconjunctivitis and urticaria. This article summarizes available data on the use of bilastine in the treatment of allergic disorders in different age groups, including younger and older adults, and school-age children and adolescents.Methods: A PubMed literature search ("bilastine") was conducted on 25 February 2019. Additional literature known to the authors and identified from the reference lists of cited publications was included.Results: Bilastine is administered orally at a dose of 20 mg once daily in adults and adolescents aged ≥12 years and 10 mg once daily in children aged 6 to <12 years. Clinical trials have demonstrated its efficacy at improving nasal and ocular symptoms in patients with allergic rhinitis, and wheals and itching in patients with urticaria. It has a rapid onset of action and long duration of action. Bilastine does not undergo significant metabolism and does not interact with the CYP450 system, which limits its potential for drug-drug interactions. No dosage adjustments are required in patients with renal or hepatic impairment, or in the elderly. Bilastine is generally well tolerated, even when administered at above-standard doses. It does not exhibit anticholinergic effects or cardiotoxic effects, shows no central nervous system penetration and has minimal sedative properties. It has been shown to improve health-related quality of life.Conclusions: Bilastine is a suitable option for the treatment of patients with allergic rhinoconjunctivitis or urticaria across age groups from school-age children to elderly patients.
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Affiliation(s)
- Martin K Church
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marysia Tiongco-Recto
- Department of Paediatrics, Section of Allergy and Immunology, University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Zoltán Novák
- Paediatric Department, University of Szeged, Szeged, Hungary
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19
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Pennington E, Yaqoob ZJ, Al-Kindi SG, Zein J. Trends in Asthma Mortality in the United States: 1999 to 2015. Am J Respir Crit Care Med 2020; 199:1575-1577. [PMID: 30917289 DOI: 10.1164/rccm.201810-1844le] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Zaid J Yaqoob
- 2 University of Central Florida Orlando, Florida and
| | | | - Joe Zein
- 1 Cleveland Clinic Cleveland, Ohio
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20
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Park S, Jung SY, Kwon JW. Sex differences in the association between asthma incidence and modifiable risk factors in Korean middle-aged and older adults: NHIS-HEALS 10-year cohort. BMC Pulm Med 2019; 19:248. [PMID: 31842862 PMCID: PMC6916451 DOI: 10.1186/s12890-019-1023-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023] Open
Abstract
Background This study investigated the sex-specific incidence of asthma and the effects of modifiable risk factors, particularly obesity, on asthma incidence among middle-aged and older individuals in Korea. Methods We used data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), which includes health examinees aged 40–79 years in 2002–2003. In total, 459,529 participants with baseline anthropometric measurements were followed-up for 10 years and the development of asthma was evaluated (2004–2013). For subgroup analysis, 246,019 participants who had body mass index (BMI) and waist circumference (WC) measurements taken in 2008–2009 were included in the analysis of the asthma incidence for 2010–2013. Factors associated with asthma were analysed using Cox proportional hazard models. Results The cohort comprised 4,248,813 (men, 2,358,541; women, 1,890,272) person-years of follow-up for 2004–2013. The asthma incidence was 10.58 and 15.03 per 1000 person-years for men and women, respectively. Asthma incidence increased with age, notably so in men. Obesity based on the baseline BMI was significantly associated with asthma development in both sexes (men, HR = 1.23, 95% confidence interval (CI) = 1.13–1.34; women, HR = 1.40 95% CI = 1.32–1.48). High WC was also related to asthma incidence in both sexes with statistical significance (men, HR = 1.34, 95% CI = 1.16–1.57; women, HR = 1.19 95% CI = 1.03–1.37). Analysis of the combined effects of BMI and WC showed that men had a higher asthma risk in the group with both general obesity and abdominal obesity than in the group with non-abdominal obesity and normal BMI. However, obese women had a higher risk of asthma regardless of abdominal obesity. Similarly, smoking was associated with asthma in both sexes but drinking and physical activity showed different associations between the sexes. Conclusions Our results revealed that asthma incidence was substantially high at old age and lifestyle factors were associated with asthma development. Practical strategies including weight control and healthy lifestyle modification are required to prevent asthma in older people.
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Affiliation(s)
- Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, South Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, South Korea.
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21
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Kim DI, Song MK, Lee K. Comparison of asthma phenotypes in OVA-induced mice challenged via inhaled and intranasal routes. BMC Pulm Med 2019; 19:241. [PMID: 31823765 PMCID: PMC6902567 DOI: 10.1186/s12890-019-1001-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Background The respiratory system is exposed to various allergens via inhaled and intranasal routes. Murine models of allergic lung disease have been developed to clarify the mechanisms underlying inflammatory responses and evaluate the efficacy of novel therapeutics. However, there have been no comparative studies on differences in allergic phenotypes following inhaled vs. intranasal allergen challenge. In this study, we compared the asthmatic features of mice challenged via different routes following allergen sensitization and investigated the underlying mechanisms. Methods To establish ovalbumin (OVA)-induced allergic asthma models, BALB/c mice were sensitized to 20 μg OVA with 1 mg aluminum hydroxide by the intraperitoneal route and then challenged by inhalation or intranasal administration with 5% OVA for 3 consecutive days. Cellular changes and immunoglobulin (Ig) E levels in bronchoalveolar lavage fluid (BALF) and serum, respectively, were assessed. Histological changes in the lungs were examined by hematoxylin and eosin (H&E) and periodic acid Schiff (PAS) staining. Levels of T helper (Th)2 cytokines including interleukin (IL)-4, -5, and -13 in BALF and epithelial cytokines including IL-25 and -33 in BALF and lung tissues were measured by enzyme-linked immunosorbent assay and western blotting. Airway hyperresponsiveness (AHR) was evaluated by assessing airway resistance (Rrs) and elastance (E) via an invasive method. Results OVA-sensitized and challenged mice showed typical asthma features such as airway inflammation, elevated IgE level, and AHR regardless of the challenge route. However, H&E staining showed that inflammation of pulmonary vessels, alveolar ducts, and alveoli were enhanced by inhaled as compared to intranasal OVA challenge. PAS staining showed that intranasal OVA challenge induced severe mucus production accompanied by inflammation in bronchial regions. In addition, Th2 cytokine levels in BALF and AHR in lung were increased to a greater extent by inhalation than by intranasal administration of OVA. Epithelial cytokine expression, especially IL-25, was increased in the lungs of mice in the inhaled OVA challenge group. Conclusion OVA-sensitized mice exhibit different pathophysiological patterns of asthma including expression of epithelial cell-derived cytokines depending on the OVA challenge route. Thus, some heterogeneous phenotypes of human asthma can be replicated by varying the mode of delivery after OVA sensitization.
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Affiliation(s)
- Dong Im Kim
- National Center for Efficacy evaluation for Respiratory disease product, Jeonbuk Department of Inhalation Research, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do, 56212, Republic of Korea
| | - Mi-Kyung Song
- National Center for Efficacy evaluation for Respiratory disease product, Jeonbuk Department of Inhalation Research, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do, 56212, Republic of Korea.,Department of human and environmental toxicology, University of Science & Technology, Daejeon, 34113, Republic of Korea
| | - Kyuhong Lee
- National Center for Efficacy evaluation for Respiratory disease product, Jeonbuk Department of Inhalation Research, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do, 56212, Republic of Korea. .,Department of human and environmental toxicology, University of Science & Technology, Daejeon, 34113, Republic of Korea.
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Li X, Chen Q, Zheng X, Li Y, Han M, Liu T, Xiao J, Guo L, Zeng W, Zhang J, Ma W. Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis. Sci Total Environ 2019; 691:549-561. [PMID: 31325855 DOI: 10.1016/j.scitotenv.2019.06.382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mounting evidence suggests that short-term exposure to ozone increases the risk of asthma exacerbations. However, ozone exposures have been assessed using ambient ozone concentrations averaged over different time periods in different studies. OBJECTIVE To evaluate the risks for asthma exacerbations related to ambient ozone measured as 1-hour or 8-hour daily maximum and 24-hour average concentrations. METHODS Based on a literature search in PubMed, EMBASE and Web of Science, we identified all time-series studies as of December 4th, 2018 and included 47 eligible studies in our analyses. Asthma exacerbation is defined as the risk for emergency room visits or hospital admissions. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) for a 10 μg/m3 increase in daily ozone concentration were estimated using random effect models. Subgroup analyses and sensitivity analyses were also performed to examine the risks for different seasons, regions and age groups and for the robustness of our main findings. RESULTS Significant and similar associations were found for O3-1 h max (RR,1.012; 95%CI, 1.005-1.019) and O3-8 h max (RR, 1.011; 95%CI, 1.007-1.014), while marginal effect was identified for O3-24 h average (RR, 1.005; 95%CI, 0.996-1.014). No significant publication bias but high heterogeneities were observed. During the warm season, ozone was significantly associated with asthma exacerbation. O3-1 h max had the highest RR of 1.014 (95%CI, 1.005-1.024), followed by O3-8 h max (RR, 1.012; 95%CI, 1.009-1.016), while marginal association was identified for O3-24 h avg (RR, 1.008; 95%CI, 0.998-1.017). During the cold season, null associations were identified for all the three averaging times. Variations were also observed in region and age. CONCLUSION Ozone exposure measured as 1-hour or 8-hour daily max were more consistently associated with asthma exacerbations than 24-hour average exposure during the warm season.
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Affiliation(s)
- Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Xueyan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Yongzhi Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Min Han
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China.
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Sohn KH, Song WJ, Kim SH, Jang HC, Kim KW, Chang YS. Chronic cough, not asthma, is associated with depression in the elderly: a community-based population analysis in South Korea. Korean J Intern Med 2019; 34:1363-1371. [PMID: 31610633 PMCID: PMC6823556 DOI: 10.3904/kjim.2018.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Depression and allergic diseases, including asthma, are frequently reported as comorbid conditions. However, their associations have been rarely examined in community-based elderly populations. METHODS The analyses were performed using the baseline data set of the Korean Longitudinal Study of Health and Aging, which consists of 1,000 elderly participants (aged > 65 years) randomly recruited from an urban community. Depression was assessed using the Geriatric Depression Scale, Center for Epidemiologic Studies Depression Scale, and Hamilton Rating Scale for Depression. Major and minor depressive disorders were diagnosed by psychiatrists. Allergic conditions were assessed using structured questionnaires, lung function, and skin prick test. Quality of life and comorbidities were assessed using structured questionnaires. RESULTS Prevalence of asthma and major depressive disorder were 5.4% and 5.3%, respectively. The rate of depression was not significantly different between the non-asthmatic and asthmatic groups. No correlation was observed between the scores obtained using the depression scales and self-reported asthma. However, chronic, frequent, and nocturnal cough were significantly associated with depression and scores obtained using the depression scales, which remained significant in multivariate logistic regression analyses (chronic cough: odds ratio [OR], 3.23; 95% confidence interval [CI], 2.57 to 12.74; p = 0.04). Rhinitis was independently associated with high Mini-Mental State Examination scores (OR, 1.11; 95% CI, 1.05 to 1.17; p < 0.001) and low 36-item short-form (OR, 0.96; 95% CI, 0.80 to 0.98; p = 0.002). CONCLUSION Depression may not be significantly associated with asthma and allergic diseases in elderly populations, but cough is a significant factor affecting depression.
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Affiliation(s)
- Kyoung-Hee Sohn
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Allergy and Immunology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak-Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Yoon-Seok Chang, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7023 Fax: +82-31-716-8349 E-mail:
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Abstract
Objective Thyroid hormones affect airway contraction, but the specific effects of
thyroid hormones on airways are controversial. Methods We divided 78 advanced-age men with asthma into 3 groups: type I respiratory
failure (RF1), type II respiratory failure (RF2), and no respiratory failure
(NRF). Pulmonary function was measured after asthma stabilization. Results The free triiodothyronine (FT3) level was significantly higher in the RF1
than RF2 group, but the free thyroxine (FT4), total thyroxine (TT4), and
thyroid-stimulating hormone (TSH) levels were not significantly different.
In the RF1, RF2, and NRF groups, the correlation coefficients between FT3
and the forced expiratory volume in1 s (FEV1) were 0.317, 0.627,
and 0.213; those between FT3 and the FEV1/forced vital capacity
(FVC) ratio were 0.287, 0.412, and 0.156; those between FT4 and
FEV1 were 0.214, 0.231, and 0.167; and those between FT4 and
the FEV1/FVC ratio were 0.211, 0.215, and 0.218, respectively. In
the RF1 and RF2 groups, the correlation coefficients between the sum
activity of peripheral deiodinases (SPINA-GD) and the FEV1/FVC
ratio were 0.164 and 0.421, and those between SPINA-GD and FEV1
were 0.284 and 0.491, respectively. Conclusion The correlation between FT3 and pulmonary function is likely caused by
changes in thyroid enzymology.
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Affiliation(s)
- Zhan Bingyan
- Respiratory Medicine Department, The West District of Qingdao Municipal Hospital Group (Qingdao Ninth People's Hospital), Qingdao, Shandong, China
| | - Wei Dong
- Respiratory Medicine Department, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
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Gómez Sáenz JT, Gérez Callejas MJ, Hidalgo Requena A, Ginel Mendoza L, González Aguilera J, Quintano Jiménez JA. [Mortality due to asthma in Spain, 1990-2015]. Semergen 2019; 45:449-457. [PMID: 31105029 DOI: 10.1016/j.semerg.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe.
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Parikh P, Wicher S, Khandalavala K, Pabelick CM, Britt RD, Prakash YS. Cellular senescence in the lung across the age spectrum. Am J Physiol Lung Cell Mol Physiol 2019; 316:L826-L842. [PMID: 30785345 PMCID: PMC6589594 DOI: 10.1152/ajplung.00424.2018] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/18/2022] Open
Abstract
Cellular senescence results in cell cycle arrest with secretion of cytokines, chemokines, growth factors, and remodeling proteins (senescence-associated secretory phenotype; SASP) that have autocrine and paracrine effects on the tissue microenvironment. SASP can promote remodeling, inflammation, infectious susceptibility, angiogenesis, and proliferation, while hindering tissue repair and regeneration. While the role of senescence and the contributions of senescent cells are increasingly recognized in the context of aging and a variety of disease states, relatively less is known regarding the portfolio and influences of senescent cells in normal lung growth and aging per se or in the induction or progression of lung diseases across the age spectrum such as bronchopulmonary dysplasia, asthma, chronic obstructive pulmonary disease, or pulmonary fibrosis. In this review, we introduce concepts of cellular senescence, the mechanisms involved in the induction of senescence, and the SASP portfolio that are relevant to lung cells, presenting the potential contribution of senescent cells and SASP to inflammation, hypercontractility, and remodeling/fibrosis: aspects critical to a range of lung diseases. The potential to blunt lung disease by targeting senescent cells using a novel class of drugs (senolytics) is discussed. Potential areas for future research on cellular senescence in the lung are identified.
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Affiliation(s)
- Pavan Parikh
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sarah Wicher
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Karl Khandalavala
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christina M. Pabelick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Rodney D. Britt
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Y. S. Prakash
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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Lee J, Kim S, Lee M, Kim B, Song W, Park H, Cho S, Hong S, Chang Y, Kim B. Different upper airway microbiome and their functional genes associated with asthma in young adults and elderly individuals. Allergy 2019; 74:709-719. [PMID: 30242844 DOI: 10.1111/all.13608] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/19/2018] [Accepted: 08/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Microbes in the airway have been shown to be associated with the pathogenesis of asthma. The upper airway microbiome influences the dysbiosis of the lower airway microbiome. However, to date, the influence of upper airway microbiome for adult and elderly asthma has not been fully elucidated. Here, the metagenome of upper airway microbiome of young adults and elderly was analyzed to identify their association with adult asthma. METHODS Nasopharyngeal swabs were collected from young adult and elderly asthma patients and non-asthmatic subjects. The compositions and functional genes of airway microbiome were analyzed by high-throughput sequencing. RESULTS The composition of microbiota differed between young adult and elderly, and it was different between asthmatics and non-asthmatics in each age group. Different bacteria were related to FEV1% predicted in each age group. Genes related to lysine degradation, N-glycan biosynthesis, caprolactam degradation, and PPAR signaling pathway, which could be related to the reduction in inflammation and degradation of air pollutants, were higher in non-asthmatics. Genes related to pentose phosphate pathway, lipopolysaccharide biosynthesis, flagella assembly, and bacterial chemotaxis-which may all be related to increased inflammation and colonization of pathogenic bacteria-were higher in young adult asthmatic patients. However, the functional genes of airway microbiome in elderly patients were not significantly different according to asthma morbidity. CONCLUSIONS These results suggest that the composition and function of upper airway microbiome could influence asthma pathogenesis, and the microbiome could play various roles depending on the age group.
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Affiliation(s)
- Jin‐Jae Lee
- Department of Life Science Multidisciplinary Genome Institute Hallym University Chuncheon Korea
| | - Sae‐Hoon Kim
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea
- Department of Internal Medicine College of Medicine Seoul National University Seoul Korea
| | - Min‐Jung Lee
- Department of Life Science Multidisciplinary Genome Institute Hallym University Chuncheon Korea
| | - Byung‐Keun Kim
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Woo‐Jung Song
- Department of Internal Medicine College of Medicine Seoul National University Seoul Korea
| | - Heung‐Woo Park
- Department of Internal Medicine College of Medicine Seoul National University Seoul Korea
| | - Sang‐Heon Cho
- Department of Internal Medicine College of Medicine Seoul National University Seoul Korea
| | - Soo‐Jong Hong
- Department of Pediatrics Childhood Asthma Atopy Center Environmental Health Center Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yoon‐Seok Chang
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea
- Department of Internal Medicine College of Medicine Seoul National University Seoul Korea
| | - Bong‐Soo Kim
- Department of Life Science Multidisciplinary Genome Institute Hallym University Chuncheon Korea
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Curto E, Crespo-Lessmann A, González-Gutiérrez MV, Bardagí S, Cañete C, Pellicer C, Bazús T, Vennera MDC, Martínez C, Plaza V. Is asthma in the elderly different? Functional and clinical characteristics of asthma in individuals aged 65 years and older. Asthma Res Pract 2019; 5:2. [PMID: 30937177 PMCID: PMC6425653 DOI: 10.1186/s40733-019-0049-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 01/04/2023] Open
Abstract
Background The prevalence of chronic diseases in the elderly (> 65 years), including asthma, is growing, yet information available on asthma in this population is scarce. Our objective is to determine the differential clinical and functional characteristics of the population > 65 years old with asthma included in the Integrated Research Programs of Asthma Databank of the Spanish Society of Pneumology and Thoracic Surgery (www.bancodatosasma.com). Methods Retrospective comparative descriptive study of demographic, clinical and functional variables for 1713 patients with asthma categorized into 3 age groups as follows: adults aged < 65 years (A), younger elderly aged 65–74 years (B) and older elderly aged ≥75 years (C). Results Predominant features of elderly patients with asthma (N = 471) were the female sex, fewer smokers, greater obesity, poorer lung function, and lower values of nitric oxide in exhaled air (p < 0.01). The most frequently associated comorbidity was gastroesophageal reflux. The highest doses of inhaled corticosteroids were by group A (60.8%). For the sample overall, 23.2% (N = 398) were being treated with omalizumab and 8.2% (N = 140) were corticosteroid-dependent (10.6% in group B). The highest percentage of patients receiving antileukotriene agents was in group B (42.9%). Conclusions Asthma in adults aged> 65 is more severe and associated with greater comorbidity, which would indicate the need for a more integrated and multidimensional approach to asthma treatment for these patients.
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Affiliation(s)
- Elena Curto
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Carrer Mas Casanovas 90, 08041 Barcelona, Spain
| | - Astrid Crespo-Lessmann
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Carrer Mas Casanovas 90, 08041 Barcelona, Spain
| | | | - Santiago Bardagí
- 2Servicio de Neumología, Consorci Sanitari del Maresme, Carrer de Cirera 230, 08304 Mataró, Barcelona, Spain
| | - Concepción Cañete
- Servicio de Neumología, Hospital General de l'Hospitalet, Av. Josep Molins 29, 08906 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Concha Pellicer
- Servicio de Neumología, Hospital Comarcal Francesc De Borja, Avinguda de la Medicina 6, 46702 Gandia, València, Spain
| | - Teresa Bazús
- 5Servicio de Neumología, Hospital Universitario Central de Asturias, Av. Roma s/n, 3301 Oviedo, Spain
| | - María Del Carmen Vennera
- 6Servició de Neumología, Hospital Clinic de Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain
| | - Carlos Martínez
- 7Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Carrer Mas Casanovas 90, 08041 Barcelona, Spain
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Ferreira MKM, Ferreira RDO, Castro MML, Magno MB, Almeida APCPSC, Fagundes NCF, Maia LC, Lima RR. Is there an association between asthma and periodontal disease among adults? Systematic review and meta-analysis. Life Sci 2019; 223:74-87. [PMID: 30849418 DOI: 10.1016/j.lfs.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/28/2022]
Abstract
This systematic review and meta-analysis aimed to investigate a possible association between asthma and periodontal disease in adults. This study was conducted by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the searches were performed on the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, OpenGrey e Google Scholar. In this systematic review, observational studies with adult humans, which evaluated patients with and without asthma, were selected to verify the association between both diseases. To qualitative analysis, Fowkes and Fulton guidelines was used and for the quantitative analysis, it was used the mean and standard deviation from each group (with and without asthma), using confidence interval (CI) 95% and heterogeneity were tested using I2 index. Furthermore, a summary of the overall strength of evidence was presented using Grading of recommendations, assessment, development, and evaluation (GRADE). 3395 studies were identified, 11 were included on this systematic review to qualitative analysis and 6 of them to quantitative synthesis. Six meta-analyses were performed to the following clinical parameters: plaque index (PI), gingival index (GI), bleeding on probing (BOP), papillary bleeding index (PBI), calculus index (CI), clinical attachment loss (CAL). The meta-analysis results for CI was (p < 0.00001, I2 = 0%) PBI (p < 0.00001, I2 = 0%), CAL (p = 0,03, I2 = 98%) showed higher means for the asthmatic group. For BOP (p = 0.20 I2 = 83%), GI (p = 0.14 I2 = 97%) and PI (p = 0.53 I2 = 95%) non-statistical difference was found. The level of evidence analysis (GRADE) presented a low level of evidence among the clinical parameters. This systematic review and meta-analysis observed that asthmatic individuals present more periodontal disease, especially gingivitis, when compared to healthy individuals, but further studies with similar methods are necessary to evaluate interactions between both diseases.
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Affiliation(s)
- Maria Karolina Martins Ferreira
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Railson de Oliveira Ferreira
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Micaele Maria Lopes Castro
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Marcela Barauna Magno
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nathalia Carolina Fernandes Fagundes
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil; School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil.
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Kirenga BJ, de Jong C, Katagira W, Kasozi S, Mugenyi L, Boezen M, van der Molen T, Kamya MR. Prevalence and factors associated with asthma among adolescents and adults in Uganda: a general population based survey. BMC Public Health 2019; 19:227. [PMID: 30795752 PMCID: PMC6387513 DOI: 10.1186/s12889-019-6562-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 02/18/2019] [Indexed: 02/02/2023] Open
Abstract
Background Recent large-scale population data on the prevalence of asthma and its risk factors are lacking in Uganda. This survey was conducted to address this data gap. Methods A general population based survey was conducted among people ≥12 years. A questionnaire was used to collect participants socio-demographics, respiratory symptoms, medical history, and known asthma risk factors. Participants who reported wheeze in the past 12 months, a physician diagnosis of asthma or current use of asthma medications were classified as having asthma. Asthmatics who were ≥ 35 years underwent spirometry to determine how many had fixed airflow obstruction (i.e. post bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio < lower limit of normal (LLN). Descriptive statistics were used to summarize participants’ characteristics. Prevalence of asthma was calculated as a proportion of asthmatics over total survey population. To obtain factors independently associated with asthma, a random-effects model was fitted to the data. Results Of the 3416 participants surveyed, 61.2% (2088) were female, median age was 30 years (IQR, 20–45) and 323 were found to have asthma. Sixteen people with asthma ≥35 years had fixed airflow obstruction. The prevalence of asthma was 11.0% (95% CI:8.9–13.2; males 10.3%, females 11.4%, urban 13.0% and rural 8.9%. Significantly more people with asthma smoked than non-asthmatics: 14.2% vs. 6.3%, p < 0.001, were exposed to biomass smoke: 28.0% vs. 20.0%, p < 0.001, had family history of asthma: 26.9% vs. 9.4%, p, < 0.001, had history of TB: 3.1% vs. 1.30%, p = 0.01, and had hypertension: 17.9% vs. 12.0%, p = 0. 003. In multivariate analysis smoking, (adjusted odds ratio (AOR), 3.26 (1.96–5.41, p < 0.001) family history of asthma, AOR 2.90 (98–4.22 p- < 0.001), nasal congestion, AOR 3.56 (2.51–5.06, p < 0.001), biomass smoke exposure, AOR 2.04 (1.29–3.21, p = 0.002) and urban residence, AOR 2.01(1.23–3.27, p = 0.005) were independently associated with asthma. Conclusion Asthma is common in Uganda and is associated with smoking, biomass smoke exposure, urbanization, and allergic diseases. Health care systems should be strengthened to provide asthma care. Measures to reduce exposure to the identified associated factors are needed. Electronic supplementary material The online version of this article (10.1186/s12889-019-6562-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bruce J Kirenga
- Makerere University Lung Institute & Division of Pulmonary Medicine, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Corina de Jong
- GRIAC-Primary Care, department of General Practice and Elderly Care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.,Groningen Research Institute for Asthma and FIXED AIRFLOW OBSTRUCTION (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Winceslaus Katagira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Samuel Kasozi
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Levicatus Mugenyi
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Center for Statistics, Interuniversity Institute for Biostatistics and statistical Bioinformatics, UHasselt (Hasselt University), Diepenbeek, Belgium
| | - Marike Boezen
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - Thys van der Molen
- GRIAC-Primary Care, department of General Practice and Elderly Care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Moses R Kamya
- Makerere University Lung Institute & Division of Pulmonary Medicine, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Liu D, He L, Ding N, Sun W, Qiu L, Xu L, Jia A, Peng C, Zhang D, Xiang X. Bronchial epithelial cells of young and old mice directly regulate the differentiation of Th2 and Th17. Biosci Rep 2019; 39:BSR20181948. [PMID: 30541898 DOI: 10.1042/BSR20181948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 12/18/2022] Open
Abstract
To determine whether or not house dust mite (HDM) and HDM+lipopolysaccharide (LPS) exposure causes a difference in T-cell subsets from young and old mice. The bronchial epithelial cells (BECs) from young and old mice were divided into three groups (PBS (control), HDM, and HDM+LPS). CD4+ naive T cells from the spleen and lymph nodes were collected after 24 h of co-culture with BECs. The number of Th2 and Th17 cells was elevated in the HDM and HDM+LPS groups compared with the control group; these responses were exacerbated when exposed to HDM+LPS. The number of HDM- and HDM+LPS-specific Th2/Th17 cells in young mice was higher than old mice; however, the Th2:Th17 cell ratio was greater in young mice, whereas the Th17:Th2 cell ratio was greater in old mice. The expression of GATA-3 and RORc was increased in the HDM+LPS and HDM groups compared with the PBS group and exhibited most in HDM+LPS group. The expression of HDM+LPS-specific GATA-3 in young mice was higher, while the expression of HDM+LPS-specific RORc in old mice was higher. Murine BECs directly regulated CD4+ naive T-cell differentiation under allergen exposure.
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Ulambayar B, Lee SH, Yang EM, Ye YM, Park HS. Association Between Epithelial Cytokines and Clinical Phenotypes of Elderly Asthma. Allergy Asthma Immunol Res 2019; 11:79-89. [PMID: 30479079 PMCID: PMC6267184 DOI: 10.4168/aair.2019.11.1.79] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 12/27/2022]
Abstract
Purpose Asthma in the elderly has different clinical features including more severe phenotypes with higher comorbidities. Epithelial cells are known to initiate innate/adaptive immune responses in asthmatic airways. We investigated clinical features and epithelial derived cytokine levels in elderly asthmatics compared to non-elderly asthmatics in a cross-sectional cohort of adult asthmatics in order to further understand its pathogenic mechanisms. Methods A total of 1,452 adult asthmatics were enrolled from a single tertiary hospital and were classified into 2 groups: 234 elderly (≥ 60 years at initial diagnosis) and 1,218 non-elderly (< 60 years at initial diagnosis) asthmatics. Asthma-related clinical parameters were compared between the 2 groups. Serum levels of epithelial cell-derived cytokines including interleukin (IL)-31, IL-33, IL-8, eotaxin-2, transforming growth factor beta 1 (TGF-β1) and periostin were measured by enzyme-linked immunosorbent assay. Results Significantly higher prevalence rates of late-onset asthma (onset age ≥ 40 years) and severe asthma, as well as the lower rate of atopy, blood/sputum eosinophil counts, total immunoglobulin E and eosinophil cationic protein levels were noted in elderly asthmatics compared to non-elderly asthmatics (P < 0.05, respectively). The forced expiratory volume in 1 second (FEV1, % predicted) level tended to be lower in elderly asthmatics (P = 0.07). In addition, serum IL-33 and IL-31 levels were significantly lower in elderly asthmatics, while no differences were found in the serum level of IL-8, eotaxin-2, TGF-β1 or periostin. Among elderly asthmatics, subjects with severe asthma had lower FEV1 (% predicted) value, but showed significantly higher serum levels of eotaxin-2 and TGF-β1, than those with non-severe asthma (P < 0.05 for each). Conclusions These findings suggest that age-related changes of epithelial cell-derived cytokines may affect clinical phenotypes and severity of elderly asthma: decreased levels of IL-33 and IL-31 may contribute to less Th2 phenotype, while increased levels of eotaxin-2 and TGF-β1 may contribute to severity.
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Affiliation(s)
- Bastsetseg Ulambayar
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - So Hee Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Yang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Park S, Choi NK, Kim S, Lee CH. The relationship between metabolic syndrome and asthma in the elderly. Sci Rep 2018; 8:9378. [PMID: 29925841 PMCID: PMC6010438 DOI: 10.1038/s41598-018-26621-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 05/10/2018] [Indexed: 01/28/2023] Open
Abstract
The burden of asthma in the elderly is increasing, but the etiology of asthma in the elderly is not clearly understood. Recent studies have reported the epidemiological link between metabolic syndrome (MS) and asthma, but it has rarely been studied in the elderly. This study investigated the association between MS and asthma and the contribution of insulin resistance (IR) and systemic inflammation to this MS-asthma association in the elderly. Our study analyzed 4,060 elderly participants (≥65 years old) from a cross-sectional survey, the Korean National Health and Nutritional Examination Survey 2007–2012. Mediation analyses were performed to examine whether IR and systemic inflammation mediates the MS-asthma association. Participants with MS had significantly higher prevalence of asthma (adjusted odds ratio = 1.34; 95% confidence interval = 1.09–1.64), and those who had greater waist circumference and lower HDL-C were especially likely to have asthma. Participants with IR and systemic inflammation were associated with higher prevalence of asthma. Prevalence of IR and systemic inflammation were higher in participants with MS or with each MS component. The MS-asthma association was substantially mediated by IR and systemic inflammation. Our study showed a significant association between MS and asthma in the elderly. MS might affect asthma through both IR and systemic inflammation.
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Affiliation(s)
- Sangshin Park
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Seungsoo Kim
- Division of Allergy and Pulmonology, Department of Internal Medicine, Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Gemicioglu B, Bayram H, Cimrin A, Abadoglu O, Cilli A, Uzaslan E, Gunen H, Akyildiz L, Suerdem M, Ozlu T, Misirligil Z. Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey. J Asthma 2018; 56:553-561. [PMID: 29714602 DOI: 10.1080/02770903.2018.1471707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients. METHODS This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months. RESULTS Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly. CONCLUSIONS Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.
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Affiliation(s)
- Bilun Gemicioglu
- a Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Hasan Bayram
- b Department of Pulmonary Diseases, Koç University , Medical School
| | - Arif Cimrin
- c Department of Pulmonary Diseases, Faculty of Medicine , Dokuz Eylul University , Izmir , Turkey
| | - Oznur Abadoglu
- d Department of Pulmonary Diseases, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Aykut Cilli
- e Department of Pulmonary Diseases, Faculty of Medicine , Akdeniz University , Antalya , Turkey
| | - Esra Uzaslan
- f Department of Pulmonary Diseases, Faculty of Medicine , Uludag University , Bursa , Turkey
| | - Hakan Gunen
- g Department of Pulmonary Diseases , Sureyyapasa Pulmonary Diseases Hospital and Research Center , Istanbul , Turkey
| | - Levent Akyildiz
- h Department of Pulmonary Diseases , Memorial Dicle Hospital , Diyarbakir , Turkey
| | - Mecit Suerdem
- i Department of Pulmonary Diseases, Faculty of Medicine , Selcuk University , Konya , Turkey
| | - Tevfik Ozlu
- j Department of Pulmonary Diseases, Faculty of Medicine , Karadeniz Teknik University , Trabzon , Turkey
| | - Zeynep Misirligil
- k Department of Pulmonary Diseases, Faculty of Medicine , Ankara University , Ankara , Turkey
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Amaral R, Fonseca JA, Jacinto T, Pereira AM, Malinovschi A, Janson C, Alving K. Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007-2012. Clin Transl Allergy 2018; 8:13. [PMID: 29755730 PMCID: PMC5934840 DOI: 10.1186/s13601-018-0201-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/26/2018] [Indexed: 12/24/2022] Open
Abstract
Background Evidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five commonly reported asthma phenotypes in US adults with current asthma and assess its association with asthma outcomes. Methods Data from the National Health and Nutrition Examination Surveys (NHANES) 2007-2012 were used (n = 30,442). Adults with current asthma were selected. Asthma phenotypes were: B-Eos-high [if blood eosinophils (B-Eos) ≥ 300/mm3]; FeNO-high (FeNO ≥ 35 ppb); B-Eos&FeNO-low (B-Eos < 150/mm3 and FeNO < 20 ppb); asthma with obesity (AwObesity) (BMI ≥ 30 kg/m2); and asthma with concurrent COPD. Data were weighted for the US population and analyses were stratified by age (< 40 and ≥ 40 years old). Results Of the 18,619 adults included, 1059 (5.6% [95% CI 5.1-5.9]) had current asthma. A substantial overlap was observed both in subjects aged < 40 years (44%) and ≥ 40 years (54%). The more prevalent specific overlaps in both age groups were AwObesity associated with either B-Eos-high (15 and 12%, respectively) or B-Eos&FeNO-low asthma (13 and 11%, respectively). About 14% of the current asthma patients were "non-classified". Regardless of phenotype classification, having concomitant phenotypes was significantly associated with (adjusted OR, 95% CI) ≥ 2 controller medications (2.03, 1.16-3.57), and FEV1 < LLN (3.21, 1.74-5.94), adjusted for confounding variables. Conclusions A prevalent overlap of commonly reported asthma phenotypes was observed among asthma patients from the general population, with implications for objective asthma outcomes. A broader approach may be required to better characterize asthma patients and prevent poor asthma outcomes.
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Affiliation(s)
- Rita Amaral
- 1CINTESIS- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Edifício Nascente, Piso 2, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal.,Department of Cardiovascular and Respiratory Sciences, Porto Health School, Porto, Portugal
| | - João A Fonseca
- 1CINTESIS- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Edifício Nascente, Piso 2, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal.,3MEDCIDS- Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Allergy, Instituto & Hospital CUF, Porto, Portugal
| | - Tiago Jacinto
- 1CINTESIS- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Edifício Nascente, Piso 2, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal.,Department of Cardiovascular and Respiratory Sciences, Porto Health School, Porto, Portugal.,Department of Allergy, Instituto & Hospital CUF, Porto, Portugal
| | - Ana M Pereira
- 1CINTESIS- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Edifício Nascente, Piso 2, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal.,Department of Allergy, Instituto & Hospital CUF, Porto, Portugal
| | - Andrei Malinovschi
- 5Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- 6Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- 7Department of Women's and Children's Health: Paediatric Research, Uppsala University, Uppsala, Sweden
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Yáñez A, Soria M, De Barayazarra S, Recuero N, Rovira F, Jares E, Stok AM, Nemirovsky S, Bueno C. Clinical characteristics and comorbidities of elderly asthmatics who attend allergy clinics. Asthma Res Pract 2018; 4:5. [PMID: 29713490 PMCID: PMC5911961 DOI: 10.1186/s40733-018-0041-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background To date, few studies have focused on the clinical and allergic characteristics of asthma in the elderly, defined as asthma in people aged 60 or over. Thus, we propose to identify and study the clinical and allergic characteristics and comorbidities of patients with asthma among the elderly. Methods A retrospective, observational, descriptive study was developed in five clinics and hospitals in Argentina. Allergy Physicians analyzed their patients' medical records in 2014 and included those adults over the age of 60, who had been diagnosed with asthma according to the GINA guidelines. Clinical and allergic characteristics were analyzed. Results A total of 152 patients diagnosed with asthma, of whom 73% were women and 11% ex-smokers, were included in this study, with a mean age of 66 years. Only 10.5% of the participants had onset asthma past the age of 60. Regarding asthma severity, 74.3% were diagnosed with moderate persistent asthma, and 7.2% with severe persistent asthma. Eighty-four percent of the patients were treated with an inhaled corticosteroid (ICS) along with a long-acting β 2-adrenergic agent (LABA). More than half of the patients had two or more comorbidities simultaneously. Allergic comorbidities were the most frequent comorbidities, followed by arterial hypertension. Among allergic comorbidities, most patients presented allergies at the nasal level. There were no significant differences between the subpopulations of patients with late-onset asthma (LOA) and asthma with onset before the age of 60, i.e. early onset asthma (EOA) in most of their clinical characteristics. However, it was observed that EOA accounted for a higher percentage of patients with nasal allergies as compared to LOA (71% vs 46%, p < 0.05).It is worth mentioning that almost half of the patients with LOA had allergies at the nasal level. Conclusion These results may provide a better understanding of the clinical characteristics of asthma in the elderly in Argentina, thus, enabling the development of future therapeutic strategies and a better quality of life for our elderly asthma patients.
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Affiliation(s)
- Anahí Yáñez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | - Marcela Soria
- Hospital Zona General de Agudos Dr. Ricardo Gutiérrez, La Plata, Argentina
| | | | - Nancy Recuero
- Allergy and Immunology Service, Hospital San Roque, Córdoba, Argentina
| | - Francisco Rovira
- Argentine Respiratory Medicine Association, Buenos Aires, Argentina
| | - Edgardo Jares
- Private Medical Centers SA, Ramos Mejía, Buenos Aires Argentina
| | - Ana María Stok
- Instituto de Investigaciones en Patologías Respiratorias, San Miguel de Tucumán, Tucumán Argentina
| | - Sergio Nemirovsky
- 7CONICET - Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - Carlos Bueno
- 7CONICET - Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina.,8Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Universidad de Buenos Aires, Laboratorio de Virología, Buenos Aires, Argentina
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Chanoine S, Sanchez M, Pin I, Temam S, Le Moual N, Fournier A, Pison C, Bousquet J, Bedouch P, Boutron-Ruault MC, Varraso R, Siroux V. Multimorbidity medications and poor asthma prognosis. Eur Respir J 2018; 51:13993003.02114-2017. [PMID: 29545275 DOI: 10.1183/13993003.02114-2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/01/2018] [Indexed: 11/05/2022]
Abstract
Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis.We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17 458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life).The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: "Few multimorbidity-related medications" (43.5%), "Predominantly allergic multimorbidity-related medications" (32.8%) and "Predominantly metabolic multimorbidity-related medications" (23.7%). Compared with women belonging to the "Few multimorbidity-related medications" profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life.The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management.
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Affiliation(s)
- Sébastien Chanoine
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Margaux Sanchez
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France
| | - Isabelle Pin
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.,Clinique de Pédiatrie, Pôle Couple Enfant, CHU Grenoble Alpes, Grenoble, France
| | - Sofia Temam
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Nicole Le Moual
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France
| | - Agnès Fournier
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Institut Gustave Roussy, Villejuif, France
| | - Christophe Pison
- Université Grenoble Alpes, Grenoble, France.,Service Hospitalier Universitaire Pneumologie-Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France.,INSERM, Laboratoire de Bioénergétique Fondamentale et Appliquée, U1055, Grenoble, France
| | - Jean Bousquet
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France.,Clinique de Pneumologie, CHU de Montpellier, Montpellier, France.,MACVIA-France, Contre les Maladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Pierrick Bedouch
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France.,CNRS, TIMC-IMAG UMR5525/ThEMAS, Université Grenoble Alpes, Grenoble, France
| | - Marie-Christine Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Institut Gustave Roussy, Villejuif, France
| | - Raphaëlle Varraso
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
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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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Wang KCW, Larcombe AN, Berry LJ, Morton JS, Davidge ST, James AL, Noble PB. Foetal growth restriction in mice modifies postnatal airway responsiveness in an age and sex-dependent manner. Clin Sci (Lond) 2018; 132:273-84. [PMID: 29263136 DOI: 10.1042/CS20171554] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/22/2023]
Abstract
Epidemiological studies demonstrate an association between intrauterine growth restriction (IUGR) and asthma; however the underlying mechanism is unknown. We investigated the impact of maternal hypoxia-induced IUGR on airway responsiveness in male and female mice during juvenility and adulthood. Pregnant BALB/c mice were housed under hypoxic conditions for gestational days 11-17.5 and then returned to normoxic conditions for the remainder of pregnancy. A control group was housed under normoxic conditions throughout pregnancy. Offspring were studied at 2 weeks (juveniles) and 8 weeks (adults), where lung volume was assessed by plethysmography, airway responsiveness to methacholine determined by the forced oscillation technique and lungs fixed for morphometry. IUGR offspring were lighter at birth, exhibited "catch-up growth" by 2 weeks, but were again lighter in adulthood. IUGR males were "hyper-responsive" at 2 weeks and "hypo-responsive" as adults, in contrast with IUGR females who were hyper-responsive in adulthood. IUGR males had increased inner and total wall thickness at 2 weeks which resolved by adulthood, while airways in IUGR females were structurally normal throughout life. There were no differences in lung volume between Control and IUGR offspring at any age. Our data demonstrate changes in airway responsiveness as a result of IUGR that could influence susceptibility to asthma development and contribute to sexual dimorphism in asthma prevalence which switches from a male dominated disease in early life to a female dominated disease in adulthood.
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Lee SH, Song WJ, Park HW, Kang MG, Kim SH, Park HK, Kim SH, Kwon YE, Kim TB, Lee BJ, Jee YK, Choi BW, Cho SH, Kim SS. Multifaceted interventions to reduce acute exacerbations in elderly asthmatics. Asia Pac Allergy 2018; 8:e1. [PMID: 29423368 PMCID: PMC5796960 DOI: 10.5415/apallergy.2018.8.e1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/27/2017] [Indexed: 01/09/2023] Open
Abstract
Background Although many risk factors are known to be associated with poor asthma outcomes in the elderly, the literature on the effect of risk factor control on asthma outcomes in the elderly is very sparse. Objective To evaluate the role of multifaceted interventions in reducing acute exacerbations in elderly asthmatics. Methods A total of 100 subjects were randomly selected from our prospective cohort of elderly asthmatics aged 65 years or older and were provided multifaceted intervention for 1 year. Our multifaceted interventions included repeated education on asthma and inhaler technique for patients and their caregivers, provision of an action plan to cope with acute exacerbations, short message service to prevent follow-up losses, and oral replacement of magnesium. The primary outcome was an acute asthma exacerbation rate compared to the previous year. Results Ninety-two subjects completed this study, although only 58 subjects continued to take magnesium. Compared to the previous year, the acute asthma exacerbation rate showed a significant reduction from 67% to 50% (p = 0001) and significant improvement was observed in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) (p = 0.04, p = 0.036 for each). Interestingly, a subgroup analysis revealed that predicted value of FEV1 increased significantly in subjects who continued to take magnesium from 79.6% to 87.1% (p = 0.008). Conclusion To reduce acute exacerbations in elderly asthmatics, a multifaceted approach in increase medical awareness, proficiency and adherence to inhaler, assistance of caregivers and correction of micronutrients deficiency is likely to be effective. In addition, a continuous oral replacement of magnesium may increase FEV1 in elderly asthmatics.
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Affiliation(s)
- So-Hee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Min-Gyu Kang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 50612, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Yong-Eun Kwon
- Department of Internal Medicine, Chosun University Medical School, Gwangju 61452, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul 05505, Korea
| | - Byung-Jae Lee
- Department of Internal Medicine, Samsung Medical Center, Seoul 06351, Korea
| | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Choenan 31116, Korea
| | - Byung-Whui Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Sun-Sin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, Korea
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Skloot GS, Busse PJ, Braman SS, Kovacs EJ, Dixon AE, Vaz Fragoso CA, Scichilone N, Prakash YS, Pabelick CM, Mathur SK, Hanania NA, Moore WC, Gibson PG, Zieman S, Ragless BB; ATS ad hoc Committee on Asthma in the Elderly. An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly. Ann Am Thorac Soc 2016; 13:2064-77. [PMID: 27831798 DOI: 10.1513/AnnalsATS.201608-658ST] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Asthma in the elderly (>65 yr old) is common and associated with higher morbidity and mortality than asthma in younger patients. The poor outcomes in this group are due, in part, to underdiagnosis and undertreatment. There are a variety of factors related to aging itself that affect the presentation of asthma in the elderly and influence diagnosis and management. Structural changes in the aging lung superimposed on structural changes due to asthma itself can worsen the disease and physiologic function. Changes in the aging immune system influence the cellular composition and function in asthmatic airways. These processes and differences from younger individuals with asthma are not well understood. Phenotypes of asthma in the elderly have not been clearly delineated, but it is likely that age of onset and overlap with chronic obstructive pulmonary disease impact disease characteristics. Physiologic tests and biomarkers used to diagnose and follow asthma in the elderly are generally similar to testing in younger individuals; however, whether they should be modified in aging has not been established. Confounding influences, such as comorbidities (increasing the risk of polypharmacy), impaired cognition and motor skills, psychosocial effects of aging, and age-related adverse effects of medications, impact both diagnosis and treatment of asthma in the elderly. Future efforts to understand asthma in the elderly must include geriatric-specific methodology to diagnose, characterize, monitor, and treat their disease.
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Abstract
This article examines how social and health inequalities shape the health impacts of climate change in the UK, and what the implications are for climate change adaptation and health care provision. The evidence generated by the other articles of the special issue were interpreted using social justice reasoning in light of additional literature, to draw out the key implications of health and social inequalities for health outcomes of climate change. Exposure to heat and cold, air pollution, pollen, food safety risks, disruptions to access to and functioning of health services and facilities, emerging infections and flooding are examined as the key impacts of climate change influencing health outcomes. Age, pre-existing medical conditions and social deprivation are found to be the key (but not only) factors that make people vulnerable and to experience more adverse health outcomes related to climate change impacts. In the future, climate change, aging population and decreasing public spending on health and social care may aggravate inequality of health outcomes related to climate change. Health education and public preparedness measures that take into account differential exposure, sensitivity and adaptive capacity of different groups help address health and social inequalities to do with climate change. Adaptation strategies based on individual preparedness, action and behaviour change may aggravate health and social inequalities due to their selective uptake, unless they are coupled with broad public information campaigns and financial support for undertaking adaptive measures.
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Affiliation(s)
- Jouni Paavola
- Centre for Climate Change Economics and Policy (CCCEP), School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK.
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Agondi RC, Andrade MC, Takejima P, Aun MV, Kalil J, Giavina-Bianchi P. Atopy Is Associated with Age at Asthma Onset in Elderly Patients. J Allergy Clin Immunol Pract 2017; 6:865-871. [PMID: 29175370 DOI: 10.1016/j.jaip.2017.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/08/2017] [Accepted: 10/25/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Asthma in the elderly population (60 years of age and older) is frequently underdiagnosed, as well as atopy. Atopy, although more prevalent in younger patients, can be a major cause of asthma in the elderly. Chronic obstructive pulmonary disease (COPD) and cardiovascular disease are common differential diagnoses, especially in elderly smokers. OBJECTIVE The objective of this study was to assess atopy and comorbidities in elderly patients with asthma. METHODS This was an observational and retrospective study involving elderly asthmatic patients followed up at a tertiary center. Patients were assessed for severity of asthma, frequency of atopy, and frequency of comorbidities concomitant with asthma. Then, they were classified according to their age at asthma onset and the groups compared with each other for atopy, spirometric parameters, and comorbidities. RESULTS This study included 243 elderly asthmatic patients, 71.8% of them presenting severe disease and 82.3% forced expiratory volume in 1 second (FEV1) < 80%. Gastroesophageal reflux disease, obesity, and asthma-COPD overlap syndrome were observed, respectively, in 64%, 37%, and 13% of these patients. Atopy was observed in 63%, mainly in those with early onset disease, and its frequency decreased as the age of asthma onset increased (P < .05). Total serum IgE was higher for allergic patients and FEV1 values were lower for patients with long-term asthma. Aspirin-exacerbated respiratory disease was more frequent in patients with nonallergic asthma. CONCLUSIONS Most elderly asthmatic patients followed up in our tertiary center were atopic and higher values of total serum IgE suggest atopy. Atopy was inversely correlated with age of asthma onset. The diagnosis of allergic asthma in the elderly population is essential to treat patients more properly, improving their quality of life and decreasing asthma morbidity and mortality.
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Affiliation(s)
- Rosana Câmara Agondi
- Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Mayra Coutinho Andrade
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Priscila Takejima
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcelo Vivolo Aun
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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Song WJ, Chang YS. Respiratory allergies in the elderly: findings from the Korean Longitudinal Study on Health and Aging phase I study (2005-2006). Asia Pac Allergy 2017; 7:185-192. [PMID: 29094015 PMCID: PMC5663745 DOI: 10.5415/apallergy.2017.7.4.185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/20/2022] Open
Abstract
Population aging is a global issue, but is estimated to be more rapid and dramatic in Asian countries. In the past, allergy might have been a minor concern in the elderly (usually defined as ≥65 years). However, recent series of epidemiologic studies indicate that allergic diseases are more prevalent than expected in the aged population. Furthermore, they pose significant impact on quality of life and socioeconomic costs. The burden may also increase in the elderly, due to frequent comorbidities and treatment-related complications. The Korean Longitudinal Study on Health and Aging (KLoSHA) cohort study is one of major research projects on the epidemiology of common geriatric disease conditions in Korea. In this review, we summarized the baseline findings on the prevalence, risk factors, comorbidities and impact of geriatric respiratory allergic conditions in the phase I KLoSHA cohort study.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Ridolo E, Rogkakou A, Ventura MT, Martignago I, Incorvaia C, Di Lorenzo G, Passalacqua G. How to fit allergen immunotherapy in the elderly. Clin Mol Allergy 2017; 15:17. [PMID: 29785175 PMCID: PMC5951166 DOI: 10.1186/s12948-017-0075-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/28/2017] [Indexed: 02/08/2023] Open
Abstract
Asthma, allergic rhinitis (AR) and atopic dermatitis are very common in young people, but in the latest decades it was increasingly recognized that also individuals of higher ages, including the population over 65 years, are concerned. Actually, it is now acknowledged the aging does not considerably alter the immune response to allergens. Allergen immunotherapy (AIT) is the only treatment that works on the causes of allergy, but elderly people are commonly excluded from AIT, except the cases of insect sting allergy. A number of recent studies showed that aged individuals also successfully respond to AIT for respiratory allergy. Therefore, there is no reason to exclude elder patients from AIT. Anyhow, clinical conditions that are considered absolute or relative contraindications are quite frequent in this aged population, thus the risk/benefit ratio must be carefully evaluated for each patient, taking into account that the more frequent occurrence of co-morbidities and the consequent need of daily-based multidrug regimen can favor adverse effects. An important issue concern the ability of AIT, and particularly of sublingual immunotherapy, to significantly improve the quality of life, that often is particularly impaired in the elderly, reducing symptoms and drugs consumption.
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Affiliation(s)
- Erminia Ridolo
- 1Medicine and Surgery Department, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Anti Rogkakou
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - Irene Martignago
- 1Medicine and Surgery Department, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | | | - Gabriele Di Lorenzo
- 5Dipartimento BioMedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università di Palermo, Palermo, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Chanoine S, Pin I, Sanchez M, Temam S, Pison C, Le Moual N, Severi G, Boutron-Ruault MC, Fournier A, Bousquet J, Bedouch P, Varraso R, Siroux V. Asthma Medication Ratio Phenotypes in Elderly Women. J Allergy Clin Immunol Pract 2017; 6:897-906.e5. [PMID: 28958739 DOI: 10.1016/j.jaip.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND With population aging, further asthma research is needed in the elderly. OBJECTIVE We assessed the relevance of the controller-to-total asthma medication ratio and its fluctuations over time to identify participants with a subsequent risk of poor asthma-related outcomes among well-characterized elderly women. METHODS We studied 4,328 women with ever asthma (69.6 ± 6.1 years) from the Asthma-E3N study (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale), which combined drug claims data since 2004 with prospective individual characteristics. The levels of the yearly controller-to-total asthma medication ratio from 2004 to 2011 were included in latent class analysis to identify groups of women characterized by specific long-term fluctuations of the ratio. Multiple regression models estimated the subsequent risk of uncontrolled asthma, asthma attacks, asthma exacerbations, and poor asthma-related quality of life associated with the level and the fluctuations of the ratio. RESULTS A short-term (12 months) ratio below 0.5 was associated with a higher risk of subsequent uncontrolled asthma, asthma attacks, asthma exacerbations (odds ratio [95% confidence interval (CI)] = 2.13 [1.41; 3.23], 1.51 [1.01; 2.26], and 2.18 [1.37; 3.44], respectively), and a lower total asthma quality of life questionnaire score (β [95% CI] = -0.49 [-0.68; -0.29]). The analysis of the long-term fluctuations of the ratio identified 5 profiles ("Never regular treatment," 53.2%; "Persistent high ratio," 21.8%; "Increasing ratio," 4.4%; "Initiating treatment," 8.8%; "Treatment discontinuation," 11.8%). The subsequent risk of poor asthma-related outcomes was significantly higher in profiles characterized by no or interrupted asthma maintenance therapy over time, compared with the "Persistent high ratio" group. CONCLUSIONS The level and the long-term fluctuations of the controller-to-total asthma medication ratio predict poor asthma-related outcomes in elderly women.
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Affiliation(s)
- Sébastien Chanoine
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 5309, Université Grenoble Alpes, Grenoble, France; Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Facultés de Médecine et de Pharmacie, Université Grenoble Alpes, Grenoble, France
| | - Isabelle Pin
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 5309, Université Grenoble Alpes, Grenoble, France; Clinique de Pédiatrie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Margaux Sanchez
- VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Institut National de la Santé et de la Recherche Médicale U1168, Villejuif, France; Université Versailles St-Quentin-en-Yvelines, Unité Mixte de Recherche Scientifique 1168, Montigny le Bretonneux, France
| | - Sofia Temam
- VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Institut National de la Santé et de la Recherche Médicale U1168, Villejuif, France; Université Versailles St-Quentin-en-Yvelines, Unité Mixte de Recherche Scientifique 1168, Montigny le Bretonneux, France; Faculté de Médecine, Université Paris Sud, Kremlin Bicêtre, France
| | - Christophe Pison
- Facultés de Médecine et de Pharmacie, Université Grenoble Alpes, Grenoble, France; Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Clinique Universitaire de Pneumologie, Grenoble, France; Laboratoire de Bioénergétique Fondamentale et Appliquée, Institut National de la Santé et de la Recherche Médicale U1055, Grenoble, France
| | - Nicole Le Moual
- VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Institut National de la Santé et de la Recherche Médicale U1168, Villejuif, France; Université Versailles St-Quentin-en-Yvelines, Unité Mixte de Recherche Scientifique 1168, Montigny le Bretonneux, France
| | - Gianluca Severi
- Center for research in Epidemiology and Population Health (CESP), Unité Mixte de Recherche Scientifique 1018, Health Across Generation Team, Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Team of Molecular and Genetic Epidemiology, Human Genetics Foundation (HuGeF), Torino, Italy; Cancer Epidemiology Centre, Cancer Council Victoria and The University of Melbourne, Melbourne, Australia
| | - Marie-Christine Boutron-Ruault
- Center for research in Epidemiology and Population Health (CESP), Unité Mixte de Recherche Scientifique 1018, Health Across Generation Team, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.
| | - Agnès Fournier
- Center for research in Epidemiology and Population Health (CESP), Unité Mixte de Recherche Scientifique 1018, Health Across Generation Team, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Jean Bousquet
- VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Institut National de la Santé et de la Recherche Médicale U1168, Villejuif, France; Université Versailles St-Quentin-en-Yvelines, Unité Mixte de Recherche Scientifique 1168, Montigny le Bretonneux, France; Clinique de Pneumologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Facultés de Médecine et de Pharmacie, Université Grenoble Alpes, Grenoble, France; Equipe Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), Centre National de la Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications (TIMC-IMAG), Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Raphaëlle Varraso
- VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Institut National de la Santé et de la Recherche Médicale U1168, Villejuif, France; Université Versailles St-Quentin-en-Yvelines, Unité Mixte de Recherche Scientifique 1168, Montigny le Bretonneux, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 5309, Université Grenoble Alpes, Grenoble, France
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Boulet LP, Robitaille C, Deschesnes F, Villeneuve H, Boulay MÈ. Comparative Clinical, Physiological, and Inflammatory Characteristics of Elderly Subjects With or Without Asthma and Young Subjects With Asthma. Chest 2017; 152:1203-1213. [PMID: 28941741 DOI: 10.1016/j.chest.2017.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asthma seems to present in the elderly as a specific phenotype that remains to be further described. In this prospective observational study, we aimed to assess the multidimensional aspects of asthma in the elderly. METHODS In young (18 to 35 years old) subjects with mild to moderate asthma and elderly subjects (aged ≥60 years) either with or without mild to moderate asthma, we compared asthma control, health care and medication use, lung function, markers of airway and systemic inflammation, and adherence to therapy. RESULTS Fifty subjects were recruited in each group. Elderly people with asthma showed more marked airway obstruction compared with young people with asthma and elderly people without asthma. They also had poorer asthma control, mainly associated with a lower FEV1, compared with young people with asthma, although airway responsiveness, health care use, prescribed doses of inhaled corticosteroids, and adherence to treatment were similar in both groups. Elderly subjects had an increase in some markers of systemic inflammation and bronchial epithelial dysfunction compared with young people with asthma. Blood eosinophils were higher in both asthma groups, particularly in elderly people with asthma. Sputum neutrophils were increased in both groups of elderly subjects and sputum eosinophils were increased in elderly people with asthma compared with the other two groups. CONCLUSIONS Asthma in the elderly presents as a specific phenotype associated with increased airway obstruction and mixed airway inflammation in addition to signs of systemic inflammation.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada.
| | - Catherine Robitaille
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Francine Deschesnes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Hélène Villeneuve
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
| | - Marie-Ève Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, PQ, Canada
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49
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Abstract
Growth of the segment of the population older than 65 years has led to intensified interest in understanding the biology of aging. This article is focused on age-related alterations in lung structure that produce predictable changes in physiologic function, both at rest and during exercise. Increased insight into the physiology of the healthy aging lung should ultimately lead to improved methods of lung function assessment in the elderly (defined as those older than 65 years) as well as better understanding of the manifestations and possibly even the treatment of geriatric lung disease.
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Affiliation(s)
- Gwen S Skloot
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box #1232, New York, NY, USA.
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50
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Abstract
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD. There are a variety of co-morbidities with EA, of which COPD, upper airway diseases, depression, obesity, and hypertension are the most common, and these co-morbidities can affect the control status of EA. However, leukotriene receptor antagonists (LTRAs) can facilitate the management of EA, and thus addition of an LTRA to inhaled corticosteroid (ICS) monotherapy or ICS plus long-acting β2-agonist therapy improves symptoms in EA patients. LTRA treatment is safe and beneficial in patients who are unable to use inhalation devices properly or who have co-morbid diseases. Therefore, clinical studies targeting a specific population of EA patients are warranted to help achieve a better therapeutic strategy in EA patients.
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Affiliation(s)
- Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ji-Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea. .,Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, South Korea.
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