Expiratory flows and airway inflammation in elderly asthmatic patients

• Published in: Respiratory medicine Vol. 105; no. 9; pp. 1284 - 1289
• Main Authors: Ducharme, Marie-Eve, Prince, Philippe, Hassan, Nesreen, Nair, Parameswaran, Boulet, Louis-Philippe
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.09.2011; Elsevier; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Age Factors; Aged; Airway inflammation; Airway management; Asthma; Asthma - drug therapy; Asthma - immunology; Asthma - physiopathology; Biological and medical sciences; Bronchitis - drug therapy; Bronchitis - immunology; Bronchitis - physiopathology; Chronic obstructive pulmonary disease, asthma; Elderly asthma; Female; Forced Expiratory Volume; Genotype & phenotype; Humans; Induced sputum; Lymphocytes - immunology; Macrophages - immunology; Male; Medical sciences; Middle Aged; Neutrophils - immunology; Older people; Pneumology; Predictive Value of Tests; Pulmonary/Respiratory; Retrospective Studies; Severity of Illness Index; Sputum - immunology; Studies; Variables; Airway inflammation; Elderly asthma; Induced sputum; Human; Lung disease; Respiratory disease; Inflammation; Asthma; Sputum; Bronchus disease; Obstructive pulmonary disease; Elderly; Pneumology
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2011.04.006

Summary Asthma in the elderly is often underrecognized and suboptimally treated, resulting in an increased morbidity and mortality. The characteristics of asthma-related bronchitis and its optimal treatment remain to be determined in this population. We aimed to compare lung function and airway inflammation in elderly and younger asthmatic subjects. Data from two induced sputum databases were analyzed in three groups of asthmatic subjects (18–30 y, n  = 136; 31–59 y, n  = 385; 60–72 y, n  = 172) and one group of healthy elderly subjects (60–89 y, n  = 16). Expiratory flows and induced sputum cell counts were analyzed. Airway obstruction was more marked in elderly asthmatics compared with healthy elderly or younger asthmatic subjects ( p  < 0.01). An increase in sputum neutrophils and a decrease in macrophages and lymphocytes were observed in elderly asthmatics ( p  < 0.0001). Neutrophil percentages significantly increased with asthma severity in the young and the middle-aged groups, while they remained similar in elderly asthmatics regardless of asthma severity ( p  < 0.05). Neutrophil percentages weakly correlated with the dose of ICS in all asthmatics ( r  = 0.17, p  < 0.0001). Age and dose of ICS were independent predictors of neutrophil percentage in asthmatic subjects in a regression model ( R2  = 0.12). Asthma in the elderly is associated with a more marked airway obstruction and sputum neutrophilia. Both age and the dose of corticosteroids need to be considered in the interpretation of the clinical relevance of sputum neutrophil count.