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Zureik M, Orehek J
Institution: National Institute of Health and Medical Research (INSERM), Unit 258, Hopital Paul-Brousse, Villejuif, France. zureik@vjf.inserm.fr
Diagnosis and severity of asthma in the elderly: results of a large survey in 1,485 asthmatics recruited by lung specialists.
Respiration. 69(3):223-8, 2002.
BACKGROUND: Despite its high prevalence, epidemiological surveys on the diagnosis and severity of asthma in the elderly are seldom. OBJECTIVE: The objectives of our study were: (i) to describe the criteria, used by French lung physicians, for the diagnosis of asthma in the elderly (age > or = 65 years); (2) to investigate whether the age at the onset of asthma is related to the severity of asthma in the elderly. METHODS: 1,485 asthmatics (783 men and 702 women; mean age +/- SD = 73.2 +/- 6.0 years) were included in this descriptive survey. They were recruited by 379 lung specialists who filled in standardized questionnaire. RESULTS: 56% of men and 10% of women (p < 0.001) were smokers or ex-smokers FEV(1)/VC was significantly lower in men than in women (60.6 +/- 16.1 versus 66.1 +/- 16.9%; p < 0.001). Diagnostic criteria of asthma were both clinical and functional in 89% of cases. Bronchospasm reversibility was tested with inhaled beta(2)-agonists (89%) and/or oral corticotherapy (36%). Asthma had been diagnosed before the age of 20 years in 10.4% of the patients, between 20 and 50 years in 28.3%, between 51 and 65 years in 38.1%, and after the age of 65 years in 23.2%. Higher FEV(1) % of theoretical values and higher FEV(1)/VC were observed in subjects with late-onset asthma. The mean of FEV(1) % of theoretical values was 58.1 +/- 19.5% in subjects with asthma diagnosis before the age of 20 years, 60.5 +/- 20.4% in those with asthma diagnosis between the age of 20 and 50 years, 62.5 +/- 19.4% in those with asthma diagnosis between the age of 50 and 65 years, and 67.1 +/- 21.4% in those with asthma diagnosis after the age of 65 years (p < 0.001). The mean number of drugs taken was significantly lower (2.2 +/- 0.4) in late-onset asthma than in early-onset asthma (2.8 +/- 0.1; p < 0.001). CONCLUSIONS: This study suggests that the severity of asthma may depend on age at the onset of symptoms and diagnosis. Early diagnosis and treatment may prevent the adverse consequences of persistentasthma. Copyright 2002 S. Karger AG, Basel.
Quadrelli SA, Roncoroni AJ
InstitutionL: Instituto de Investigaciones Medicas Alfredo Lanari, Universidad de Buenos Aires, Argentina. ilanari@impsat1.com.ar
Is asthma in the elderly really different?
Respiration. 65(5):347-53, 1998.
Abstract To examine the nature of asthma in the elderly, we compared older (group 1: 65 years or older, n = 50) with younger patients (group 2: <40 years, n = 99) and to determine the influence of long-standing disease, elderly asthmatics with early onset (group A: onset before 40, n = 22) were compared with patients developing symptoms later in their lives (group B: onset after 40, n = 22). Blood eosinophilia and IgE value >/=100 IU/l were more frequent in younger patients. Short symptom-free periods were more frequent among older asthmatics (78.5 vs. 45.4%, p < 0.001). Only 31.2% of older patients had only mild symptoms. Requirement of systemic steroids was higher in the elderly population. The worst FEV1 was lower in older patients (54.4 +/- 17.3 vs. 71.8 +/- 18.5%, p </= 0.001). Patients with early-onset asthma showed more frequently shorter symptom-free periods (93.3 vs. 53.3%, p <0.05), higher emergency admissions/year, and hospitalizations/year. Best FEV1 (group 1: 66.7 +/- 13.7% vs. group 2: 90.3 +/- 15.1%, p < 0.005) and worst FEV1 (46.2 +/- 13.1 vs. 61.0 +/- 13.2%, p < 0.01) were lower in early-onset patients. A higher systemic steroid requirement, a lower best and worst FEV1, shorter symptom-free periods and a lesser proportion of patients with only mild symptoms were observed in patients older than 65 with early-onset asthma compared with those younger than 40 years. Elderly patients with a shorter duration of asthma were not different from young patients. Our study strongly suggests that severity of asthma and development of irreversible airflow obstruction depend on the duration of disease.
Ishioka S, Terada M, Haruta Y, Hiyama K, Hozawa S, Yamakido M
Institution: Second Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan.
Multiple logistic regression analysis of risk factors for the development of steroid-dependent asthma in the elderly: a comparison with younger asthmatics.
Respiration. 68(1):35-40, 2001
BACKGROUND: The percentage of the aged among all patients with bronchial asthma is increasing. OBJECTIVE: To investigate the risk factors for the development of steroid-dependent asthma in the elderly. METHODS: A multiple logistic regression analysis involving various clinical factors between steroid-dependent and -independent asthma was carried out for 59 asthmatics aged over 60 years, including 16 patients with steroid-dependent asthma. The calculated risk for each factor was compared with that obtained from 122 younger asthmatics aged 20-59 years. RESULTS: Among the factors examined (sex, age, period from onset of asthma, type of asthma and family history of asthma, plus history of smoking, atopic dermatitis, allergic rhinitis, chronic sinusitis and nasal polyps), the significant risk factors for the development of steroid dependency in the elderly asthmatics were only family history of bronchial asthma (relative risk 3.6) and smoking history (relative risk 6.9). CONCLUSIONS: Some risk factors for steroid-dependent asthma in younger individuals were not significant in the elderly. Since the smoking history was most closely associated with the development of steroid dependency in the elderly, even though most of them had quit smoking, it is important for patients with asthma to avoid smoking. Copyright 2001 S. Karger AG, Basel
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