title: Effects of older age and age of asthma onset on clinical and inflammatory variables in severe refractory asthma.
abstract: Asthma in the elderly as well as asthma of adult-onset has been associated with increased morbidity, but little is known specifically about the effects of age on clinical and inflammatory outcomes in severe refractory asthma. The aims of the study were to examine the effects of age [<65 versus ≥65 years] and age of onset of asthma [childhood-onset, <18 versus adult-onset, ≥18 years] on clinical and inflammatory variables in patients with severe asthma.
  
  
  
  In 1042 subjects with refractory asthma recruited to the British Thoracic Society Severe Asthma Registry, we compared patient demographics, disease characteristics and biomarkers of inflammation in patients aged <65 years (n = 896) versus ≥65 years (n = 146) and onset at age <18 years (n = 430) versus ≥18 years (n = 526).
  
  
  
  Severe asthma patients aged ≥65 years had improved symptom control, better asthma quality of life and in the last year, less emergency visits and rescue oral steroid courses [3 (1-6) versus 5 (2-7), p < 0.001] than severe asthmatics aged <65 years. Blood eosinophils were lower in the elderly group. Patients with severe adult-onset asthma had similar symptom control, lung function and health-care utilization compared to severe childhood-onset asthma. Adult-onset asthmatics had higher blood eosinophils and were less atopic.
  
  
  
  Patients with severe refractory asthma aged ≥65 years exhibit better clinical and health care outcomes and have lower blood eosinophils compared to those aged <65 years. Severe refractory adult-onset asthma is associated with similar levels of asthma control, higher blood eosinophils and less atopy than severe refractory childhood-onset asthma.
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK. Electronic address: rekhachaudhuri@yahoo.com.
authors: Rekha
authors: R
authors: Chaudhuri
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK.
authors: Charles
authors: C
authors: McSharry
authors: Centre for Infection & Immunity, Queen's University of Belfast, UK.
authors: Liam G
authors: LG
authors: Heaney
authors: The University of Manchester, UK; University Hospital of South Manchester, UK.
authors: Robert
authors: R
authors: Niven
authors: Department of Infection, Inflammation & Immunity, Institute for Lung Health, University of Leicester, UK.
authors: Christopher E
authors: CE
authors: Brightling
authors: Royal Brompton Hospital, London, UK.
authors: Andrew N
authors: AN
authors: Menzies-Gow
authors: Stobhill Hospital, Glasgow, UK.
authors: Christine
authors: C
authors: Bucknall
authors: Birmingham Heartlands Hospital, University of Birmingham, UK.
authors: Adel H
authors: AH
authors: Mansur
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK.
authors: Waiting
authors: W
authors: Lee
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK.
authors: Malcolm
authors: M
authors: Shepherd
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK.
authors: Mark
authors: M
authors: Spears
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK.
authors: Douglas C
authors: DC
authors: Cowan
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors: Holger
authors: H
authors: Husi
authors: Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK.
authors: Neil C
authors: NC
authors: Thomson
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged / Q000706:statistics & numerical data*; D001249:Asthma / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers; D004804:Eosinophils / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood; D007249:Inflammation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012129:Respiratory Function Tests / Q000379:methods; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide; D007073:Immunoglobulin E
keywords: Adult-onset; Asthma; Asthma duration; Childhood-onset; Elderly; Inflammatory biomarker