title: Effect of aging on sputum inflammation and asthma control.
abstract: BACKGROUND
  Aged asthmatic patients experience increased morbidity and mortality. Knowledge of the aging effect on airway inflammation and asthma control is limited.
  
  
  OBJECTIVE
  We sought to compare airway inflammation and its relationship to asthma control in aged versus younger patients and determine whether differences are asthma specific or caused by "inflamm-aging."
  
  
  METHODS
  We performed a prospective study of aged (>60 years) and younger (21-40 years) inner-city patients with asthma. After a run-in period to control for inhaled corticosteroid use, induced sputum was collected. Age-matched nonasthmatic control subjects were included to measure age-related inflammatory changes.
  
  
  RESULTS
  Aged (mean age, 67.9 ± 5.1 years; n = 35) compared with younger (mean age, 30.8 ± 5.9 years; n = 37) asthmatic patients had significantly worse asthma control and lower FEV1. Aged asthmatic patients had higher sputum neutrophil (30.5 × 104/mL and 23.1%) and eosinophil (7.0 × 104/mL and 3.8%) numbers and percentages compared with younger patients (neutrophils, 13.0 × 104/mL [P < .01] and 6.9% [P < .01]; eosinophils, 2.0 × 104/mL [P < .01] and 1.2% [P < .01]). Aged asthmatic patients had higher sputum IL-6 (P < .01) and IL-8 (P = .01) levels. No significant inflammatory differences between aged and younger control subjects were observed. In aged asthmatic patients increased sputum IL-6 and macrophage inflammatory protein 3α/CCL20 levels were significantly associated with decreased asthma control and increased sputum neutrophil numbers and IL-1β, IL-6, and macrophage inflammatory protein 3α/CCL20 levels were associated with hospitalization.
  
  
  CONCLUSIONS
  The inflammatory patterns of aged versus younger asthmatic patients are associated with increased sputum neutrophil and eosinophil values and cytokine levels related to neutrophil recruitment. Differences in airway inflammation can contribute to diminished asthma control in the aged. Further understanding of asthma pathophysiology in aged patients is needed to improve management of this vulnerable population.
authors.affiliation: Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: paula.busse@mssm.edu.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Busse
authors.affiliation: Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Janette M
authors.initials: JM
authors.lastname: Birmingham
authors.affiliation: Rho, Federal Systems Division, Chapel Hill, NC.
authors.forename: Agustin
authors.initials: A
authors.lastname: Calatroni
authors.affiliation: Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Manzi
authors.affiliation: Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Anna
authors.initials: A
authors.lastname: Goryachokovsky
authors.affiliation: Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Giselle
authors.initials: G
authors.lastname: Fontela
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000276:immunology* / Q000502:physiology; D001249:Asthma / Q000276:immunology* / Q000503:physiopathology; D016207:Cytokines / Q000276:immunology; D004804:Eosinophils / Q000276:immunology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000503:physiopathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D013183:Sputum / Q000166:cytology / Q000276:immunology*; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D055815:Young Adult
chemical_list: D016207:Cytokines
keywords: Asthma; inflammation; inner city; sensitization; sputum