Asthma in the elderly: The role of exhaled nitric oxide measurements

Columbo, Michele; Wong, Bruce; Panettieri, Reynold A.; Rohr, Albert S.

doi:10.1016/j.rmed.2013.01.018

Cited by 24 publications

(13 citation statements)

References 8 publications

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“…Similar to other studies [10], including ours of FENO in elderly asthmatics [11], we found no association between FENO and FEV 1 , FEV 1 /FVC, or FEF 25-75% throughout the study period.…”

Section: Discussionsupporting

confidence: 90%

The effect of multiple allergen immunotherapy on exhaled nitric oxide in adults with allergic rhinitis

Columbo

Wong

Panettieri

et al. 2013

All Asth Clin Immun

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BackgroundThere is a lack of objective measures of the clinical efficacy of allergen immunotherapy which relies on patients’ perception about the effect of this treatment. We studied whether the fraction of exhaled nitric oxide is affected by multiple allergen immunotherapy in polysensitized adult subjects with allergic rhinitis. We also looked for associations between exhaled nitric oxide and subjects’ demographics, symptom scores, and pulmonary function tests.MethodsTwenty adult, polysensitized subjects with seasonal and perennial allergic rhinitis who chose to undergo allergen immunotherapy were enrolled. They were evaluated at baseline, and 4, 8, 12, 24, and 52 weeks later. Exhaled nitric oxide was reported as the mean of triplicate determinations.FindingsOur results indicate that multiple allergen immunotherapy did not affect exhaled nitric oxide levels and such levels did not correlate with subjects’ demographics and pulmonary function tests. However, exhaled nitric oxide was associated with rhinoconjuctivitis and asthma symptom scores at the end of the study.ConclusionsIn polysensitized adult subjects with allergic rhinitis, exhaled nitric oxide levels are unaffected by multiple allergen immunotherapy.

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“…Similar to other studies [10], including ours of FENO in elderly asthmatics [11], we found no association between FENO and FEV 1 , FEV 1 /FVC, or FEF 25-75% throughout the study period.…”

Section: Discussionsupporting

confidence: 90%

The effect of multiple allergen immunotherapy on exhaled nitric oxide in adults with allergic rhinitis

Columbo

Wong

Panettieri

et al. 2013

All Asth Clin Immun

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“…Exhaled nitric oxide fraction ( F eNO ) has been proposed as a marker of airway eosinophilic inflammation; therefore, it is plausible that it could play a role in the diagnosis of asthma in elderly patients. Unfortunately, data that have specifically addressed this issue are limited and mostly influenced by the use of inhaled corticosteroids (ICS) [ 37 ]. Of note, in healthy subjects, F eNO levels appear to show a triphasic shape with an ascendant loop during adolescence, a plateau in adults and a linear increase in the elderly until age 80 years [ 38 ].…”

Section: Diagnosis Of Asthma In Advanced Agementioning

confidence: 99%

Asthma in the elderly: a different disease?

Battaglia

Benfante

Spatafora

et al. 2016

Breathe

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Key pointsAsthma in the elderly can be difficult to identify due to modifications of its clinical features and functional characteristics.Several comorbidities are associated with asthma in the elderly, and this association differs from that observed in younger patients.In clinical practice, physicians should treat comorbidities that are correlated with asthma (i.e. rhinitis or gastro-oesophageal reflux), assess comorbidities that may influence asthma outcomes (i.e. depression or cognitive impairment) and try to prevent comorbidities related to ‘drug-associated side-effects (i.e. cataracts, arrhythmias or osteoporosis).“Geriatric asthma” should be the preferred term because it implies the comprehensive and multidimensional approach to the disease in the older populations, whereas “asthma in the elderly” is only descriptive of the occurrence of the disease in this age range.Educational aimsTo present critical issues in performing differential diagnosis of asthma in the elderly.To offer the instrument to implement the management of asthma in the most advanced ages.Asthma is a chronic airway disease that affects all ages, but does this definition also include the elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological studies and clinical experience support the concept that asthma is as prevalent in older age as it is in the young. With the ever-increasing elderly population worldwide, the detection and proper management of the disease in old age may have a great impact from the public health perspective. Whether asthma in the elderly maintains the same characteristics as in young populations is an interesting matter. The diagnostic process in older individuals with suspected asthma follows the same steps, namely a detailed history supported by clinical examination and laboratory investigations; however, it should be recognised that elderly patients may partially lose reversibility of airway obstruction. The correct interpretation of spirometric curves in the elderly should take into account the physiological changes in the respiratory system. Several factors contribute to delaying the diagnosis of asthma in the elderly, including the age-related impairment in perception of breathlessness. The management of asthma in advanced age is complicated by the comorbidities and polypharmacotherapy, which advocate for a comprehensive approach with a multidimensional assessment. It should be emphasised that older age frequently represents an exclusion criterion for eligibility in clinical trials, and current asthma medications have rarely been tested in elderly asthmatics. Ageing is associated with pharmacokinetic changes of the medications. As a consequence, absorption, distribution, metabolism and excretion of antiasthmatic medications can be variably affected. Similarly, drug-to-drug interactions may reduce the effectiveness of inhaled medications and increase the risk of side-effects. For this reason, we propose the term “geriatric asthma” be preferred to the more generic “asthma i...

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“…In elderly patients with asthma, we have previously studied the role of exhaled nitric oxide measurements and vitamin D [ 2 , 3 ]. Indeed, there is growing interest in the possible role of dietary supplements (e.g., vitamins and methyl donors) in asthma [ 4 , 5 ].…”

Section: Resultsmentioning

confidence: 99%

Asthma in the elderly: the effect of choline supplementation

Columbo

Rohr

2016

Allergy Asthma Clin Immunol

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BackgroundAsthma in the elderly is poorly understood as very few studies have included these patients. DNA methylation can affect the expression of asthma susceptibility genes. Methyl groups can be produced through a choline dependent pathway. Asthmatics have decreased serum choline. We studied the effect of choline supplementation in elderly asthmatics and associations between different parameters at baseline.MethodsThis is a double-blind, placebo-controlled, cross-over study. Thirty asthmatics 65 years old and older were evaluated at baseline and 3, 6, 9, and 12 weeks later. They randomly received choline bitartrate 310 mg and placebo capsules twice daily for 6 weeks.ResultsNinety percent of the study subjects were atopic and 97 % of them were using inhaled corticosteroids. Choline supplementation did not affect ACT (asthma control test), spirometric values, eosinophil counts or total serum IgE vs. placebo (p > 0.86 for all comparisons). In subjects with lower ACT (≤20), lower FEV1 % (<60 %), or higher eosinophil counts (≥0.6), there was similarly no difference between choline and placebo (p > 0.63). We found no significant association between eosinophil counts and IgE and the other parameters at baseline including in subjects with lower ACT or on higher inhaled steroid doses (p > 0.09). Asthmatic women had lower baseline ACT scores compared to men (p = 0.02).ConclusionsIn this study of elderly asthmatics, choline supplementation for 6 weeks did not affect ACT scores, spirometric values, peripheral blood eosinophils, or total serum IgE. These results will require confirmation in larger and longer studies.Trial registration ClinicalTrials.gov NCT02371993

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Asthma in the elderly: The role of exhaled nitric oxide measurements

Cited by 24 publications

References 8 publications

The effect of multiple allergen immunotherapy on exhaled nitric oxide in adults with allergic rhinitis

The effect of multiple allergen immunotherapy on exhaled nitric oxide in adults with allergic rhinitis

Asthma in the elderly: a different disease?

Asthma in the elderly: the effect of choline supplementation

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