Priority Research Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, University of Newcastle, Newcastle, N.S.W., Australia.
Respiration. 2014;87(1):63-74. doi: 10.1159/000352053. Epub 2013 Sep 11.
The progression of obstructive airway diseases (OADs) including asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome in older adults is not well understood.
To examine the prognosis of OADs and to identify potential determinants for longitudinal changes in clinical outcomes.
We consecutively recruited 99 older adults (>55 years) with OADs who underwent a multidimensional assessment at baseline and 4 years which involved spirometry, 6-min walk distance (6MWD), assessments of health status (Saint George's Respiratory Questionnaire, SGRQ), comorbidity, and serum and sputum biomarkers. All-cause mortality and respiratory hospitalisation during the follow-up period were recorded. Clinical outcomes were compared between basal and final visits, and changes in clinical outcomes were compared among asthma, COPD and asthma-COPD overlap groups. Associations between clinical parameters, biomarkers and prognosis were examined.
After a median follow-up of 4.2 years, outcome data were available for 75 (75.8%) patients. There were 16 (16.2%) deaths. The BODE index predicted all-cause mortality in older people with OADs. While spirometry, 6MWD and SGRQ deteriorated significantly over the 4 years, there was significant heterogeneity in the longitudinal changes in these clinical outcomes. Participants with COPD had a significant decline in FEV1 (p = 0.003), SGRQ (p = 0.030) and 6MWD [decline of 75.5 (93.4) m, p = 0.024]. The change in 6MWD was lower in the asthma-COPD overlap group. Airflow reversibility was associated with a reduced decline in 6MWD.
COPD patients had a poor prognosis compared with asthma and asthma-COPD overlap patients. The BODE index is a useful prognostic indicator in older adults with OADs. Both airway disease diagnosis and BODE index warrant specific attention in clinical practice.
老年人阻塞性气道疾病（OAD）包括哮喘、慢性阻塞性肺疾病（COPD）和哮喘-COPD 重叠综合征的进展情况尚不清楚。
检查 OAD 的预后，并确定与临床结局纵向变化相关的潜在决定因素。
我们连续招募了 99 名年龄在 55 岁以上的 OAD 患者，他们在基线和 4 年后接受了多维评估，包括肺功能检查、6 分钟步行距离（6MWD）、健康状况评估（圣乔治呼吸问卷，SGRQ）、合并症和血清及痰生物标志物。在随访期间记录了全因死亡率和呼吸住院情况。比较了基础和最终就诊时的临床结局，并比较了哮喘、COPD 和哮喘-COPD 重叠组之间的临床结局变化。检查了临床参数、生物标志物与预后之间的关系。
中位随访 4.2 年后，75 名（75.8%）患者可获得结局数据。有 16 例（16.2%）死亡。BODE 指数预测了 OAD 老年患者的全因死亡率。虽然在 4 年内肺功能、6MWD 和 SGRQ 显著恶化，但这些临床结局的纵向变化存在显著异质性。COPD 患者的 FEV1（p = 0.003）、SGRQ（p = 0.030）和 6MWD（下降 75.5（93.4）m，p = 0.024）显著下降。哮喘-COPD 重叠组的 6MWD 变化较低。气道可逆性与 6MWD 下降减少相关。
与哮喘和哮喘-COPD 重叠患者相比，COPD 患者的预后较差。BODE 指数是 OAD 老年患者有用的预后指标。气道疾病诊断和 BODE 指数在临床实践中都需要特别注意。
