Age is associated with asthma phenotypes

Abstract

Older subjects with asthma have low odds of atopic and eosinophilic phenotypes, whereas they present high odds of irreversible airway obstruction and severe asthma.

Rural to urban migration contributes to the high burden of asthma in the urban area

“…Our study demonstrated that atopy, according to the result of the skin prick test or total IgE, was less frequent among rural‐urban migrants in comparison to urban‐born subjects. Age and ICS did not bias this association, as we adjusted the analyzes for these confounding variables . As before mentioned, the explanation for this association is that the rural environment exposes subjects to immunomodulatory stimuli that downregulate the immune system, preventing inappropriate immune response to non‐harmful environmental antigens .…”

Year in review 2017: Chronic obstructive pulmonary disease and asthma

“…Asthma is becoming common in older subjects and recently developed treatments for asthma are guided by phenotype . Asthmatic subjects aged 65 years or older were found to have lower odds of atopic and eosinophilic phenotypes compared with younger subjects, although they had higher odds of irreversible airway obstruction and severe asthma …”

“…As with COPD, clinical assessment and management of asthma have been the focus of numerous studies. Not only do severity and risk increase with age, but disease severity in childhood has been demonstrated to predict respiratory capacity later in life . Novel treatment strategies include a focus on the microbiome, with administration of probiotics for both prevention and treatment .…”

Phenotyping asthma: More complex than just age

“…Once the problem has been identified, studies aimed at a better understanding and characterization of this population and therapeutic interventions can be done. The current study identified elderly asthmatic patients as less atopic, less eosinophilic, more symptomatic and with a high prevalence of irreversible airway obstruction; these patients are recognized as less likely to respond to existing anti‐inflammatory therapies. These results challenge us to seek new interventions.…”

“…These results challenge us to seek new interventions. It is important to remember that asthmatic patients over 65 years are consistently excluded from large clinical trials; Ponte et al . have highlighted the need to evaluate the particular (potential?)…”