title: Role of eosinophilic inflammation and atopy in elderly asthmatic patients.
abstract: BACKGROUND
  Asthma in the elderly is severe and associated with poor treatment outcome. Although atopy has an important role in pathogenesis, its role in the elderly is unclear, partly due to immune senescence.
  
  
  OBJECTIVE
  We aimed to examine the associations of Th2-mediated inflammation with asthma severity in the elderly.
  
  
  METHODS
  Consecutive asthmatics older than 60 years without severe exacerbation within 8 weeks were enrolled. Atopic status was determined by positive serum specific IgE or skin prick test to common aeroallergens. Serum total IgE was measured simultaneously to exhaled fractional concentration of nitric oxide (FeNO). Asthma control level was assessed by using Thai Asthma Control Test (ACT) score.
  
  
  RESULTS
  Total of 44 elderly asthmatic patients were enrolled. The mean age was 68.9 years and mean age of asthma diagnosis was 46.6 years. Seventy-seven percent of patients were female. Atopic status was found in 45.5% of patients. Uncontrolled asthma classified as ACT score < 20 was noted in 25% of elderly asthma, but its association with either high serum total IgE (≥120 IU/mL), high FeNO (≥50 ppb) or atopic status was not detected.
  
  
  CONCLUSIONS
  One-fourth of elderly asthmatics were clinically uncontrolled, while atopy was confirmed in 45.5%. Neither high total IgE, high FeNO nor atopic status was associated with uncontrolled asthma in the elderly. Other factors might play role in asthma severity in the elderly, and has to be further investigated.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Theerasuk
authors.initials: T
authors.lastname: Kawamatawong
authors.affiliation: Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Sitthisak
authors.initials: S
authors.lastname: Siripongpun
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Ticha
authors.initials: T
authors.lastname: Rerkpattanapipat
keywords: Asthma control; Atopy; Elderly; Eosinophilic inflammation