Age-Related Clinical Characteristics, Inflammatory Features, Phenotypes, and Treatment Response in Asthma
Age-Related Clinical Characteristics, Inflammatory Features, Phenotypes, and Treatment Response in Asthma
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哮喘与年龄相关的临床特征、炎症特征、表型和治疗反应
DOI：
10.1016/j.jaip.2022.09.029
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发表时间：
2023-01-05
影响因子：
9.4
通讯作者：
Wang，Gang
中科院分区：
文献类型：
--
作者：
Wang，Ji;Zhang，Xin;Wang，Gang
BackgroundEmerging证据表明，老化影响哮喘的结果，但机制仍然在很大程度上unexplored.ObjectiveTo探讨年龄相关的临床特征，炎症特征，表型，和治疗反应在asthma.MethodsThis是一个前瞻性队列研究的哮喘患者与12个月的后续行动，在现实世界的设置。在不同年龄组中评估临床炎症和表型特征、未来加重风险和治疗反应（青年定义为18 - 39岁;中年定义为40 - 64岁;结果与青年组（n = 106）和中年组（n = 179）相比，老年患者（n = 55）的气道阻塞更严重，合并症（包括慢性阻塞性肺病和糖尿病）更多，特应性较低，IgE和FeNO水平较低，并且更有可能患有迟发性和固定性气流阻塞性哮喘，并且2型哮喘的风险降低。老年哮喘患者诱导痰中IFN-γ、IL-17 A和IL-8水平显著升高（均P <0.05）。路径分析表明，年龄直接和显着导致未来的哮喘加重，部分介导的气道IFN-γ的上调。此外，老年哮喘患者的治疗反应降低，（FEV 1改善≥ 12%或> 200 mL，且博格评分降低≥ 1）（校正比值比= 0.11; 95% CI，0.02-0.52;校正比值比= 0.12; 95%CI，分别为0.03-0.49）。结论本研究证实，哮喘在老年人群中代表了一种特殊的表型，并表明，老龄化可以影响哮喘的临床特征，炎症特征，急性发作，和治疗反应。
BackgroundEmerging evidence suggests that aging affects asthma outcomes, but the mechanism remains largely unexplored.ObjectiveTo explore age-related clinical characteristics, inflammatory features, phenotypes, and treatment response in asthma.MethodsThis was a prospective cohort study of asthmatic patients with a 12-month follow-up in a real-world setting. Clinical inflammatory and phenotypic characteristics, future risk for exacerbations, and treatment response were assessed across different age groups (young was defined as age 18 to 39 years; middle-aged, 40 to 64 years; and elderly, 65 years or older).ResultsCompared with young (n = 106) and middle-aged (n = 179) asthmatic patients, elderly patients (n = 55) had worse airway obstruction, more comorbidities including chronic obstructive pulmonary disease and diabetes, less atopy, and lower levels of IgE and FeNO, and were more likely to have late-onset and fixed airflow obstruction asthma and a reduced risk for having type 2 profile asthma. Levels of IFN-gamma, IL-17A, and IL-8 in induced sputum were significantly increased in elderly asthmatic patients (allP< .05). Path analysis indicated that age directly and significantly led to future exacerbations in asthma, partially mediated by an upregulation of airway IFN-gamma. Moreover, elderly patients with asthma had a reduced treatment response (improvement in FEV1of 12% or greater, or 200 mL, and a reduction in Borg scores of 1 or greater) (adjusted odds ratio = 0.11; 95% CI, 0.02-0.52; and adjusted odds ratio = 0.12; 95% CI, 0.03-0.49, respectively).ConclusionsThis study confirms that asthma in the elderly population represents a specific phenotype and indicates that aging can influence asthma in terms of clinical characteristics, inflammatory features, exacerbations, and treatment response.