Bellia Vincenzo, Pedone Claudio, Catalano Filippo, Zito Anna, Davì Eva, Palange Stefania, Forastiere Francesco, Incalzi Raffaele Antonelli
Università degli studi di Palermo-DIMPEFINU, Via Trabucco 180, 90146 Palermo, Italy.
Chest. 2007 Oct;132(4):1175-82. doi: 10.1378/chest.06-2824. Epub 2007 Sep 21.
There is a distinct lack of information on the prognosis of asthma in the elderly.
In order to compare mortality rates of elderly people with and without asthma and to identify mortality risk factors in those with asthma, 1,233 ambulatory patients aged > or = 65 years with a diagnosis of asthma (n = 210) or chronic nonrespiratory conditions (n = 1,023) were enrolled in a multicentric study. Patients underwent baseline spirometry and multidimensional assessment and were then followed up for a mean of 57.9 months (SD 16.9). We compared mortality rates in the two groups and identified predictors of death using multivariable survival analysis.
The 5-year mortality rate in people with asthma was 24.3%, compared to 16.3% in control subjects (p < 0.01), but asthma per se did not explain the excess risk of death. The main causes of death among people with and without asthma were cardiovascular diseases (36.4% and 21.3%, respectively), nonneoplastic lung diseases (28.8% vs 5.4%), and neoplasms (7.6% vs 22.6%). In people without asthma, death was associated with age, gender, smoking, cardiovascular diseases, worse performance on a 6-min walking test, cognitive impairment, depression, and worse respiratory function. In people with asthma, only the association between death and age, smoking, and depression was confirmed. At variance with control subjects, in asthmatics we found an inverse correlation between being overweight and death (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.13 to 0.94) and a trend toward a higher mortality rate in people with a body mass index < 22 kg/m(2) (HR, 2.21; 95% CI, 0.94 to 5.18).
Asthma in the elderly was associated with higher mortality rate, although this condition was not an independent risk factor. Causes of death and factors associated with death were somewhat different between people with and without asthma.
关于老年人哮喘预后的信息明显匮乏。
为比较有哮喘和无哮喘老年人的死亡率，并确定哮喘患者的死亡风险因素，1233名年龄≥65岁的门诊患者纳入一项多中心研究，其中诊断为哮喘的患者210例，患有慢性非呼吸道疾病的患者1023例。患者接受了基线肺功能测定和多维度评估，随后平均随访57.9个月（标准差16.9）。我们比较了两组的死亡率，并使用多变量生存分析确定死亡预测因素。
哮喘患者的5年死亡率为24.3%，而对照组为16.3%（p<0.01），但哮喘本身并不能解释额外的死亡风险。有哮喘和无哮喘患者的主要死亡原因是心血管疾病（分别为36.4%和21.3%）、非肿瘤性肺部疾病（28.8%对5.4%）和肿瘤（7.6%对22.6%）。在无哮喘患者中，死亡与年龄、性别、吸烟、心血管疾病、6分钟步行试验表现较差、认知障碍、抑郁以及呼吸功能较差有关。在哮喘患者中，仅证实死亡与年龄、吸烟和抑郁之间存在关联。与对照组不同，在哮喘患者中，我们发现超重与死亡之间存在负相关（风险比[HR]，0.35；95%置信区间[CI]，0.13至0.94），且体重指数<22kg/m²的患者死亡率有升高趋势（HR，2.21；95%CI，0.94至5.18）。
老年人哮喘与较高的死亡率相关，尽管该疾病不是独立的风险因素。有哮喘和无哮喘患者的死亡原因及与死亡相关的因素有所不同。
