Asthma in the elderly - Cockroach sensitization and severity of airway obstruction in elderly nonsmokers
Asthma in the elderly - Cockroach sensitization and severity of airway obstruction in elderly nonsmokers
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DOI：
10.1378/chest.122.5.1580
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发表时间：
2002-11-01
期刊：
影响因子：
9.6
通讯作者：
Reibman, J
中科院分区：
文献类型：
--
作者：
Rogers, L;Cassino, C;Reibman, J
研究目的：验证室内过敏原致敏与老年哮喘患者气道阻塞严重程度增加相关的假设。设计：在公立医院哮喘诊所登记的受试者进行队列研究。环境：纽约市一家市立公立医院的哮喘诊所，服务于贫困人口。患者：在Bellevue医院哮喘诊所登记的年龄大于或等于60岁的哮喘患者。总血清IgE和过敏原特异性IgE测量在一组老年不吸烟的哮喘患者（45例）中进行，这些患者在支气管扩张剂（BD）治疗前后进行了肺活量测定。测量和结果：放射性过敏原吸收试验结果表明，大多数受试者（即60%）对至少一种过敏原敏感，其中许多人对至少一种室内过敏原敏感。蟑螂（CR）是受试者最常见的致敏过敏原，47%的受试者血清特异性IgE水平升高。对尘螨、猫、狗或豚草过敏的受试者较少。与未对CR （CR-）致敏的受试者相比，对CR （CR+）致敏的受试者气流减少更大[预测FEV1为64 +/- 4.4% vs 77.1 +/- 4.1%；P < 0.05]。在给予BD治疗后，只有29%的CR+受试者获得了正常的BD后FEV1，而CR-受试者的这一比例为58%。肺容量测量在CR+和CR-受试者之间存在差异，CR+受试者的功能残余容量升高更大。结论：在老年城市哮喘患者人群中，cr特异性血清IgE的存在与更严重的哮喘相关，反映在气道阻塞和恶性通货膨胀的增加上。
Study objectives: To test the hypothesis that the presence of sensitization to indoor allergens is associated with increased severity of airway obstruction in elderly subjects with asthma.Design: Cohort study of subjects enrolled in a public hospital asthma clinic.Setting: Asthma clinic in a municipal public hospital serving an indigent population in New York city.Patients: Subjects aged greater than or equal to 60 years with asthma who were enrolled in the Bellevue Hospital Asthma Clinic. Total serum IgE and allergen-specific IgE measurements were performed in a cohort of elderly never-smokers who had asthma (45 patients) who had undergone spirometry before and after bronchodilator (BD) therapy.Measurements and results: The results of radioallergosorbent tests demonstrated that most subjects (ie, 60%) were sensitized to at least one allergen, with many sensitized to at least one indoor allergen. Cockroach (CR) was the most common allergen to which subjects were sensitized, with 47% displaying an elevated serum-specific IgE level. Fewer subjects were sensitized to dust mite, cat, dog, or ragweed. Subjects sensitized to CR (CR+) had greater reductions in airflow compared to subjects not sensitized to CR (CR-) [64 +/- 4.4% predicted vs 77.1 +/- 4.1% predicted FEV1, respectively; p < 0.05]. Following BD administration, only 29% of CR+ subjects achieved a normal post-BD FEV1 compared to 58% of CR- subjects. Lung volume measurements differed between CR+ and CR- subjects, with a greater elevation of functional residual capacity in CR+ subjects.Conclusion: In a population of elderly urban patients with asthma, the presence of CR-specific serum IgE is associated with more severe asthma, as reflected by an increase in airway obstruction and hyperinflation.