Preferences help
enabled [disable] Abstract
Number of results
2017 | 22 | 1 | 17-22
Article title

Fenotypy astmy oskrzelowej w starszym wieku

Title variants
Phenotypes of asthma in the elderly
Languages of publication
Asthma has similar prevalence in all age groups. In elderly patients asthma is often undiagnosed, wrongly diagnosed and/or undertreated. Treatment of elderly patients is troublesome because of comorbidities, more frequent cognitive limitations, greater burden of disease and pathophysiological process of aging. In the age of personalized medicine physicians use phenotypes to improve diagnostics and develop individual treatment. In the paper we discuss phenotypes of asthma in the elderly patients. Asthma can be differentiated to age (childhood asthma, adult asthma and elderly asthma) or the age of asthma onset (early and late asthma onset). Also, there is a classification based on the dominant inflammatory cells (eosinophilic asthma, neutrophilic asthma). Other phenotypes are connected with different comorbidities (obesity asthma phenotype, COPD, neuropsychiatric disorders). We describe classification methods including cluster analysis and point out the most important similarities within the groups.
Astma występuje z podobną częstością w każdej grupie wiekowej. U osób starszych astma jest zbyt rzadko rozpoznawana lub błędnie rozpoznawana i niedostatecznie leczona. Leczenie starszych pacjentów jest często utrudnione przez współchorobowość, częstsze ograniczenia funkcji poznawczych, większe obciążenie chorobą oraz zmiany patofizjologiczne związane z wiekiem. W dobie medycyny spersonalizowanej lekarze wykorzystują podział fenotypowy dla ułatwienia diagnozowania i doboru właściwego sposobu leczenia. Często stosuje się podziały w zależności od aktualnego wieku pacjenta (astma dziecięca, dorosłych i osób starszych) lub wieku wystąpienia choroby (astma o wczesnym i późnym początku). Wśród osób starszych spotyka się podział związany z dominującymi komórkami zapalnymi, wyróżnia się astmę eozynofilową i neutrofilową. Często uwzględnia się problem współwystępowania otyłości i zaburzeń neuropsychiatrycznych u starszych pacjentów z astmą. W artykule przedstawiono najczęstsze metody klasyfikacji pacjentów z astmą oskrzelową, w tym metodę klastrową. Przedstawiono najważniejsze publikacje i opisane w nich cechy charakterystyczne dla każdej grupy

Physical description
  • Klinika Immunologii, Reumatologii i Alergii Katedry Immunologii Klinicznej i Mikrobiologii Uniwersytetu Medycznego w Łodzi
  • Klinika Immunologii, Reumatologii i Alergii Katedry Immunologii Klinicznej i Mikrobiologii Uniwersytetu Medycznego w Łodzi
  • 1. Oraka E, Kim HJ, King ME, et al. Asthma prevalence among US elderly by age groups: age still matters. J Asthma 2012; 49: 593-9.
  • 2. Ventura MT, Scichilone N, Gelardi M, Patella V, Ridolo E. Management of allergic disease in the elderly: key considerations, recommendations and emerging therapies. Expert Rev Clin Immunol 2015;11: 1219-28.
  • 3. Parameswaran K, Hildreth AJ, Chadha D, et al. Asthma in the elderly: underperceived, underdiagnosed and undertreated; a community survey. Respir Med 1998; 92: 573-7.
  • 4. Enright PL, McClelland RL, Newman AB, et al. Underdiagnosis and undertreatment of asthma in the elderly. Cardiovascular Health Study Research Group. Chest 1999; 116: 603-13.
  • 5. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017. Published online:
  • 6. Plaza V, Serra-Batlles J, Ferrer M, et al. Quality of life and economic features in elderly asthmatics. Respiration 2000; 67: 65-70.
  • 7. Ozturk AB, Iliaz S. Challenges in the management of severe allergic asthma in the elderly. J Asthma Allergy 2016; 9: 55-63.
  • 8. Sin DD, Tu JV. Underuse of inhaled steroid therapy in elderly patients with asthma. Chest 2001; 119: 720-5.
  • 9. Hartert TV, Togias A, Mellen BG, et al. Underutilization of controller and rescue medications among older adults with asthma requiring hospital care. J Am Geriatr Soc 2000; 48: 651-7.
  • 10. Bellia V, Pedone C, Catalano F, et al. Asthma in the elderly: mortality rate and associated risk factors for mortality. Chest 2007; 132: 1175e1182.
  • 11. Moorman JE, Rudd RA, Johnson CA, et al. Centers for Disease Control and Prevention (CDC). National surveillance for asthma ‒ United States, 1980-2004. MMWR Morb Mortal Wkly Rep 2007; 56: 1-54.
  • 12. US Department of Health and Human Services. Administration on Aging. A profile of older Americans: 2008.
  • 13. De Martinis M, Sirufo MM, Ginaldi L. Allergy and Aging: An Old/ New Emerging Health Issue. Aging and Disease 2017; 8: 162-75.
  • 14. Lin TY, Poon AH, Hamid Q. Asthma phenotypes and endotypes. Curr Opin Pulm Med 2013; 19: 18-23.
  • 15. Wardzyńska A, Kowalski ML. Astma w wieku starszym. Astma, Alergia, Immunologia 2015; 20: 159-66.
  • 16. Moore WC, Meyers DA, Wenzel SE, et al. Identification of asthma phenotypes using cluster analysis in the severe asthma research program. Am J Respir Crit Care Med 2010; 181: 315-23.
  • 17. Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 2008; 178: 218-24.
  • 18. Amelink M, de Nijs SB, de Groot JC, et al. Three phenotypes of adult-onset asthma. Allergy 2013; 68: 674-80.
  • 19. Kiley J, Smith R, Noel P. Asthma phenotypes. Curr Opin Pulm Med 2007; 13: 19-23.
  • 20. Wenzel SE. Severe asthma in adults. Am J Respir Crit Care Med 2005; 172: 149-60.
  • 21. Tan DJ, Walters EH, Perret JL, et al. Age-of-asthma onset as a determinant of different asthma phenotypes in adults: a systematic review and meta-analysis of the literature. Expert Rev Respir Med 2015; 9: 109-23.
  • 22. Hanania NA, King MJ, Braman SS, et al. Asthma in the Elderly: Current Understanding and Future Research Needs: A Report of a National Institute on Aging (NIA) Workshop. J Allergy Clin Immunol 2011; 128: S4-S24.
  • 23. Kitch BT, Levy BD, Fanta CH. Late onset asthma: epidemiology, diagnosis and treatment. Drugs & Aging 2000; 17: 385-97.
  • 24. Battaglia S, Benfante A, Spatafora M, Scichilone N. Asthma in the Elderly: A Different Disease? Breathe (Sheff) 2016; 12: 18-28.
  • 25. Di Lorenzo G, Di Bona D, La Piana S, et al. Bronchial asthma-emerging therapeutic strategies. (w) Allergic Asthma and Aging. Sapey E (red.). Rijeka: InTech; 2012.
  • 26. Jenkins HA, Cherniack R, Szefler SJ, et al. A comparison of the clinical characteristics of children and adults with severe asthma. Chest 2003; 124: 1318-24.
  • 27. Perret JL, Dharmage SC, Matheson MC, et al. The interplay between the effects of lifetime asthma, smoking, and atopy on fixed airflow obstruction in middle age. Am J Respir Crit Care Med 2013; 187: 42-8.
  • 28. Burgess JA, Matheson MC, Gurrin LC, et al. Factors influencing asthma remission: a longitudinal study from childhood to middle age. Thorax 2011; 66: 508-13.
  • 29. Benfante A, Sorino C, Scichilone C. The asthma-COPD overlap syndrome (ACOS): hype or reality? Shortness of Breath 2014; 3: 165- 74.
  • 30. Weatherall M, Travers J, Shirtcliffe PM, et al. Distinct clinical phenotypes of airways disease defined by cluster analysis. Eur Respir J 2009; 34: 812e8.
  • 31. Soriano JB, Davis KJ, Coleman B, et al. The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom. Chest 2003; 124: 474e81.
  • 32. Nielsen M, Barnes CB, Ulrich CS. Clinical characteristics of the asthma-COPD overlap syndrome-a systemic review. Int J Chron Obstruct Pulmon Dis 2015; 10: 1443-54.
  • 33. Global Initiative for Chronic Obstructive Lung Disease [webpage on the Internet]. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease [updated April 2, 2015].
  • 34. Sano H, Iwanaga T, Nishiyama O, et al. Characteristics of phenotypes of elderly patients with asthma. Allergol Int 2016; 65: 204e209.
  • 35. Postma DS, Rabe KF. The asthma-COPD overlap syndrome. N Engl J Med 2015; 373: 1241-9.
  • 36. National Heart, Lung, and Blood Institute [webpage on the Internet]. NAEPP Working Group Report. Considerations for Diagnosing and Managing Asthma in the Elderly. Available from: http://msdh.
  • 37. Chen MH, Li CT, Tsai CF, et al. Risk of dementia among patients with asthma: a nationwide longitudinal study. J Am Med Dir Assoc 2014; 15: 763-7.
  • 38. Bozek A, Jarzab J. Improved activity and mental function related to proper antiasthmatic treatment in elderly patients with Alzheimer’s disease. Allergy Asthma Proc 2011; 32: 341-5.
  • 39. Sutherland TJT, Cowan JO, Taylor DR. Dynamic hyperinflation with bronchoconstriction: differences between obese and nonobese women with asthma. Am J Respir Crit Care Med 2008; 177: 970-5.
  • 40. Song WJ, Kim SH, Lim S, et al. Association between obesity and asthma in the elderly population: potential roles of abdominal subcutaneous adiposity and sarcopenia. Ann Allergy Asthma Immunol 2012; 109: 243-8.
  • 41. Sutherland ER, Goleva E, King TS, et al. Cluster analysis of obesity and asthma phenotypes. PLoS One 2012; 7: e36631.
  • 42. Amelink M, de Groot JC, de Nijs SB, et al. Severe adult-onset asthma: A distinct phenotype. J Allergy Clin Immunol 2013; 132: 336- 41.
  • 43. Mathur SK, Schwantes EA, Jarjour NN, et al. Age-Related Changes in Eosinophil Function in Human Subjects. CHEST 2008; 133: 412- 19.
  • 44. Wang W, Huang KW, Wu BM, et al. Correlation of eosinophil counts in induced sputum and fractional concentration of exhaled nitric oxide and lung functions in patients with mild to moderate asthma. Chin Med J (Engl) 2012; 125: 3157-60.
  • 45. Łacwik P, Kupczyk M, Kuna P. Fenotypy astmy ciężkiej w praktyce klinicznej, Alergia Astma Immunologia 2013; 18: 71-6.
  • 46. Song WJ, Sintobin I, Sohn KH, et al. Staphylococcal enterotoxin IgE sensitization in late-onset severe eosinophilic asthma in the elderly. Clin Exp Allergy 2016; 46: 411-21.
  • 47. Miranda C, Busacker A, Balzar S, et al. Distinguishing severe asthma phenotypes: Role of age at onset and eosinophilic inflammation J Allergy Clin Immunol 2004; 113: 101-8.
  • 48. Nyenhuis SM, Schwantes EA, Evans MD, Mathur SK. Airway neutrophil inflammatory phenotype in older asthma subjects. J Allergy Clin Immunol 2010; 125: 1163-5.
  • 49. Boulay M-E, Robitaille C, Deschesnes F, et al. Characteristics of the "Asthma in the Elderly" Phenotype. Am J Respir Crit Care Med 2017; 195: A1317.
  • 50. Park HW, Song WJ, Kim SH, et al. Classification and implementation of asthma phenotypes in elderly patients. Ann Allergy Asthma Immunol 2015; 114: 18-22.
  • 51. Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. J Allergy Clin Immunol 2007; 119: 405-13.
Document Type
Publication order reference
YADDA identifier
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.