Clinical characterization of Bronchial Asthma in Elderly and Non-Elderly Patients: the relevance of clinical phenotypes

• Autor(a) principal: Rodrigues, Bruna Filipa Vilaça
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/5359
• topic: Bronchial Asthma; Clinical Characterization; Elderly; Non-Elderly; Phenotypes; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Background: Bronchial Asthma is a chronic inflammatory disease that affects about 300 million people worldwide. It is extremely important to compare clinical and functional features of asthma between elderly (EA) and non elderly (NEA) patients because several aspects of the diagnosis are different. Furthermore, in elderly asthmatic patients, late-onset (LOA) / adult-onset asthma (AOA) seems to be more frequent than long standing (LSA) / early-onset (EOA) / childhood-onset asthma (COA) and the former may be more frequently associated with more severe forms of asthma. In addition, in elderly patients, asthma frequently co-exists with other heart and lung diseases, particularly with chronic heart failure and chronic obstructive pulmonary disease (COPD). Thus, a thorough study of the clinical characteristics of bronchial asthma, taking into account the age of onset could help to clarify undervalued aspects of the clinical expression of the disease as well as different profiles of expression that are associated with clinical phenotypes. Such characterization may contribute towards better control of the disease as improvement in quality of life, once the appropriately tailored medication, taking into consideration phenotypic differences is given, particularly in the elderly. Methods: Analytic and cross-sectional study in which the target population was composed of individuals with a confirmed diagnosis of asthma, who were either between 18-64 years or 65 years or older and were regularly followed up at an Immunoallergology or Pulmonology outpatient clinic of CHCB. All volunteers answered a questionnaire about personal and family history of respiratory disease, current and past occupational exposure, characterization of the place of residence, co-morbidities, usual medication, asthma triggers, number of acute crises and admittance to wards, principal symptoms and their frequency, asthma control medication, among other factor. Results were analyzed using the Software Package for Social Sciences (SPSS). Results: Overall, 192 volunteers were included, with a median age of 59.1 years and predominantly of the female gender. Most patients were smokers, had a low level of schooling and social class and lived in urban areas. The predominant phenotype found was that of LSA/EOA/COA in association with atopic asthma, and mostly only partially or not controlled. For EA patients, the most prevalent and associated phenotypes were LOA/AOA with non-atopic asthma. In contrast, for NEA patients the most predominant phenotype was the combination of LSA/EOA/COA with atopic asthma. In terms of co-morbidities, rhinitis or a combination of rhinitis with dermatitis was significantly more common in the LSA/EOA/COA phenotype. In addition, a previous history of allergies was more frequently reported in EA patients with the LSA/EOA/COA phenotype. In terms of quality of life, NEA patients with LOA/AOA phenotype were 4.48 times more likely to have limitation of activities caused by dyspnoea than NEA patients with the LSA/EOA/COA phenotype. On the other hand, the LOA/AOA phenotype was more frequently associated with limitation of activities caused by coughing and a higher frequency of wheezing manifestation (more than twice weekly) as well as having to use short-acting beta2-agonist (SABA) rescue medication. On the other hand, the beta2-agonists long-action (LABA) and anti-leukotrienes were more frequently associated with LOA/AOA. Conclusion: LOA/AOA and LSA/EOA/COA phenotypes have significant differences in terms of manifestations of severity, family history of diseases and control medication. Nevertheless, these phenotypes may manifest to a similar extent, in different age groups.