title: Expiratory flows and airway inflammation in elderly asthmatic patients.
abstract: 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 (R(2) = 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.
authors.affiliation: Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, 2725, chemin Ste-Foy, Québec (Québec), Canada. meve_ducharme@hotmail.com
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Ducharme
authors.forename: Philippe
authors.initials: P
authors.lastname: Prince
authors.forename: Nesreen
authors.initials: N
authors.lastname: Hassan
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Nair
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D001991:Bronchitis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008214:Lymphocytes / Q000276:immunology*; D008264:Macrophages / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013183:Sputum / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones