Effects of older age and age of asthma onset on clinical and inflammatory variables in severe refractory asthma. (September 2016)

• Record Type: Journal Article
• Authors: Chaudhuri, Rekha; McSharry, Charles; Heaney, Liam G.; Niven, Robert; Brightling, Christopher E.; Menzies-Gow, Andrew N.; Bucknall, Christine; Mansur, Adel H.; Lee, Waiting; Shepherd, Malcolm; Spears, Mark; Cowan, Douglas C.; Husi, Holger; Thomson, Neil C.
• Is Part Of: Respiratory medicine. Volume 118(2016)
• Page Start: 46
• Page End: 52
• Publication Date: 2016-09
• Subjects: Asthma -- Adult-onset -- Asthma duration -- Childhood-onset -- Elderly -- Inflammatory biomarker; ACQ Asthma control questionnaire -- AQLQ Asthma quality of life questionnaire -- ATS American Thoracic Society -- BMI Body mass index -- BTS British Thoracic Society -- CAP IgE antibody enzyme-immunoassay -- ERS European Respiratory Society -- EuroQoL European Quality of Life -- FENO50 Fraction of expired nitric oxide 50 ml/s -- FEV1 Forced expiratory volume in one second -- FVC forced vital capacity -- GORD gastro-oesophageal reflux disease -- HAD Hospital Anxiety and Depression -- ICS Inhaled corticosteroid -- IL Interleukin -- ITU Intensive Therapy Unit -- Kco Transfer coefficient of the lung -- LABA Long-acting beta2-agonist -- RV Residual volume -- SABA Short acting beta2-agonist -- SARP American Severe Asthma Research Programme -- TLC Total lung capacity -- VAS Visual analogue scale; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2016.07.005
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Asthma in the elderly as well as asthma of adult-onset has been associated with increased morbidity, but little is known specifically about the effects of age on clinical and inflammatory outcomes in severe refractory asthma. The aims of the study were to examine the effects of age [<65 versus ≥65 years] and age of onset of asthma [childhood-onset, <18 versus adult-onset, ≥18 years] on clinical and inflammatory variables in patients with severe asthma. Methods: In 1042 subjects with refractory asthma recruited to the British Thoracic Society Severe Asthma Registry, we compared patient demographics, disease characteristics and biomarkers of inflammation in patients aged <65 years (n = 896) versus ≥65 years (n = 146) and onset at age <18 years (n = 430) versus ≥18 years (n = 526). Results: Severe asthma patients aged ≥65 years had improved symptom control, better asthma quality of life and in the last year, less emergency visits and rescue oral steroid courses [3 (1–6) versus 5 (2–7), p < 0.001] than severe asthmatics aged <65 years. Blood eosinophils were lower in the elderly group. Patients with severe adult-onset asthma had similar symptom control, lung function and health-care utilization compared to severe childhood-onset asthma. Adult-onset asthmatics had higher blood eosinophils and were less atopic. Conclusions: Patients with severe refractory asthma aged ≥65 years exhibit better clinical and health care outcomes and have lower blood eosinophils compared to those aged <65 years. Severe refractory adult-onset asthma is associated with similar levels of asthma control, higher blood eosinophils and less atopy than severe refractory childhood-onset asthma. Highlights: Older people with severe asthma have better clinical outcomes than those <65 years. Severe asthma in older people is also associated with lower blood eosinophils. Clinical outcomes are similar in early-onset and adult-onset severe asthma. Severe adult-onset asthma is associated with high blood eosinophils and less atopy.