Abstract
BackgroundElderly asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as compared to younger patients.MethodsWe conducted a retrospective analysis on a series of 758 asthmatics subdivided in three groups: lower than 40, between 40 and 70 and older than 70. All the patients who had a successful sputum induction were included in the study.ResultsOlder patients had a higher Body Mass Index, had less active smokers and were more often treated with Long Acting anti-Muscarinic Agents. We found a significant increase in sputum neutrophil counts with ageing. There was no significant difference in blood inflammatory cell counts whatever the age group. Forced expiratory volume in one second (FEV1) and FEV1/FVC values were significantly lower in elderly who had lower bronchial hyperresponsiveness and signs of air trapping. We found a lower occurrence of the allergic component in advanced ages. Asthmatics older than 70 years old had later onset of the disease and a significant longer disease duration.ConclusionOur study highlights that asthmatics older than 70 years old have higher bronchial neutrophilic inflammation, a poorer lung function, signs of air trapping and lower airway variability. The role of immunosenescence inducing chronic low-grade inflammation in this asthma subtype remains to be elucidated.
Highlights
Asthmatics represent an important group that is often excluded from clinical studies
We found a significant increase in sputum neutrophil counts with ageing
Looking at asthma inflammatory phenotypes, we found a higher proportion of neutrophilic asthma (22%, defined as sputum neutrophils > 76%) and mixed granulocytic asthma (10%, defined as sputum neutrophils > 76% and sputum eosinophils > 3%), while there was a lower proportion of paucigranulocytic (33%) and eosinophilic asthma (35%) in older asthmatics (Table 4)
Summary
Asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as compared to younger patients. Bronchial asthma is a chronic inflammatory disease of the airways. Because of improved life expectancy, the proportion of individuals aged upper than 70 years old is growing worldwide. Asthma in the elderly exacerbates as often as in non-elderly asthma and different predictors of exacerbations were recently identified with fixed airway obstruction and chronic rhinosinusitis being predictors. Asthma in older adults is either diagnosed after the age of 70 or have a history of long-standing disease. Asthma in the elderly is often underdiagnosed or diagnosed as COPD leading to improper treatment
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