Duration of Asthma and Physiologic Outcomes in Elderly Nonsmokers

Cassino, Cara; Berger, Kenneth I.; Goldring, Roberta M.; Norman, Robert G.; Kammerman, Sandra; Ciotoli, Carlo; Reibman, Joan

doi:10.1164/ajrccm.162.4.9912140

Cited by 90 publications

(58 citation statements)

References 27 publications

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“…Why severe-persistent asthma of a longer duration appears to be associated with sputum eosinophilia, yet mild non-ICS treated asthma of a longer duration appears not to be, is an interesting question. A possible explanation for this apparent paradox may be that the persistence of eosinophilic inflammation may lead to the development of severe disease despite treatment with ICS, although other factors, particularly airway remodelling [29] and autonomic dysfunction [27] are important in the pathophysiological deterioration in lung function that is associated with longer asthma duration [30].…”

Section: Discussionmentioning

confidence: 99%

Reduced eosinophil apoptosis in induced sputum correlates with asthma severity

et al. 2003

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This study was carried out to investigate the relationship between induced sputum eosinophil apoptosis and clinical severity score, airway obstruction and symptom scores in patients with chronic stable asthma.Altogether, 41 chronic stable asthmatic subjects of varying severity defined by Aas score and 17 control subjects underwent spirometry, symptom questionnaire and successful sputum induction. Sputum was processed and cytospins prepared for light microscopy to determine normal and apoptotic eosinophils.Mild asthmatic subjects had a significantly lower percentage sputum eosinophils and a significantly higher eosinophil apoptotic ratio (AR) than moderate or chronic severe asthmatics. Severe asthmatic subjects had a significantly greater age, duration of asthma and sputum eosinophil count?mL -1 than mild asthmatic subjects. Asthmatic subjects9 symptom scores, severity scores and age inversely correlated with AR and the percentage of sputum eosinophils. Baseline forced expiratory volume in one second inversely correlated with percentage sputum eosinophils and positively correlated with AR.The study demonstrates a relationship between reduced sputum eosinophil apoptosis and increased clinical severity of chronic stable asthma, providing additional evidence that eosinophil apoptosis may be important in the resolution of eosinophilic airway inflammation in asthma. Eur Respir J 2003; 22: 484-490.

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Section: Discussionmentioning

confidence: 99%

Reduced eosinophil apoptosis in induced sputum correlates with asthma severity

et al. 2003

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“…The reduction in lung function in asthma appears to be related to duration and clinical severity [199,200,[202][203][204][205]. In some studies of chronic, severe asthma, persistent airflow obstruction has been shown to be related both to inflammation, based upon exhaled nitric oxide and blood eosinophilia, and to remodelling, shown as increased wall thickness on CT scan [206].…”

Section: Fixed Airflow Obstruction and Decline In Lung Function In Asmentioning

confidence: 99%

Clinical relevance of airway remodelling in airway diseases

James¹,

Wenzel²

2007

Eur Respir J

307

214

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Asthma and chronic obstructive pulmonary disease (COPD) are characterised by airflow obstruction, airway remodelling (measurable structural change) and inflammation. The present review will examine the relationship between airway remodelling in these two conditions with respect to symptoms, abnormal lung function, airway hyperresponsiveness and decline in lung function. The potential for remodelling to be a protective response will also be discussed.Asthma is associated with variable symptoms and changes in lung function and also fixed abnormalities of lung function and an increased rate of decline in lung function with age. There is a relative preservation of the relaxed airway lumen dimensions, prominent thickening of the smooth muscle layer and reduced airway distensibility. The severity of asthma is related to the degree of airway remodelling, which is most marked in cases of fatal asthma.In COPD, symptoms are persistent and predictable but also progressive and are related to fixed abnormalities of lung function. Remodelling is associated with narrowing of the airway lumen and an increased thickness of the airway wall, although not usually to the extent seen in asthma. COPD is most often due to smoking where there is also remodelling of the parenchyma that may contribute to symptoms.

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“…Long considered a disease of childhood or young adulthood, its prevalence is now known to be similar in older people [4].…”

Section: Epidemiologymentioning

confidence: 99%

“…It is recognized as a more severe asthma phenotype with a greater degree of airflow obstruction, more frequent exacerbations, and a greater rate of lung function decline. In a study comparing patients with asthma of long duration and patients with asthma of short duration, it was found that the duration of asthma is associated with the degree of airflow limitation [4].…”

Section: Immune-senescence and Asthmamentioning

confidence: 99%

“…Because of the high prevalence of chronic bronchitis and emphysema among the elderly, a 2-to 3-week trial of systemic corticosteroids was suggested to detect "significant reversibility of airway disease" in patients thought to have asthma who fail to demonstrate reversibility on pulmonary function testing [22]. Because seniors have decreased awareness of bronchoconstriction, decreased physiologic responses to hypoxemia and hypercapnia, and more advanced airway obstruction than younger asthmatic patients, pulmonary function testing could be more appropriate to use than symptoms as the primary guide for treatment [4,22]. The lack of an evidence-based approach to asthma in the elderly was attributed in part to the systematic exclusion of the elderly from clinical trials of asthma therapy [97].…”

Section: Treatment Of Asthma In Older Patientsmentioning

confidence: 99%

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