Ryu Kai, Fukutomi Yuma, Nakatani Eiji, Iwata Maki, Nagayama Kisako, Yano Koichi, Nakamura Yuto, Hamada Yuto, Watai Kentaro, Kamide Yosuke, Sekiya Kiyoshi, Araya Jun, Kuwano Kazuyoshi, Taniguchi Masami
Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan; Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
Allergol Int. 2023 Apr;72(2):252-261. doi: 10.1016/j.alit.2022.10.005. Epub 2022 Nov 9.
Frailty is a geriatric syndrome of age-related physiological decline, which is associated with higher mortality and decreased healthy life expectancy, and muscle weakness is one of the presentations of frailty. We investigated an association between lifetime oral corticosteroid (OCS) exposure with frailty and muscle weakness among elderly patients with asthma.
We studied 203 consecutive elderly outpatients with asthma aged ≥60 years old. They were classified into three groups according to their cumulative lifetime OCS dose (lifetime non-users, lower-dose users, and higher-dose users), which was retrospectively estimated from the response to a structured questionnaire. The prevalence of frailty determined by the Kihon Checklist was compared between the three groups. Hand-grip strength, and lean mass index were also measured as markers of muscle strength.
Thirty-seven percent of the patients studied were considered frail. Higher cumulative lifetime OCS exposure was associated with a significantly higher prevalence of frailty (33% in lifetime non-users, 59% in lower-dose users, and 68% in higher-dose users; P for trend <0.005). This was also associated with lower hand-grip strength in both sexes (P for trend; 0.012 in men, and 0.020 in women), and lower lean mass index in men (P for trend 0.002). However, current doses of OCS were not significantly associated with these outcomes.
Cumulative lifetime OCS exposure was associated with a higher prevalence of frailty and muscle weakness. These findings emphasize the importance of minimizing lifetime OCS exposure for the prolongation of healthy life expectancy in patients with asthma.
衰弱是一种与年龄相关的生理衰退的老年综合征，与较高的死亡率和健康预期寿命降低相关，而肌肉无力是衰弱的表现之一。我们调查了老年哮喘患者终生口服糖皮质激素（OCS）暴露与衰弱和肌肉无力之间的关联。
我们研究了203例年龄≥60岁的连续性老年哮喘门诊患者。根据他们终生OCS累积剂量将其分为三组（终生未使用者、低剂量使用者和高剂量使用者），通过对一份结构化问卷的回答进行回顾性估算。比较三组中由简易体能检查表确定的衰弱患病率。还测量了握力和瘦体重指数作为肌肉力量的标志物。
37%的研究患者被认为衰弱。终生OCS暴露累积量越高，衰弱患病率显著越高（终生未使用者为33%，低剂量使用者为59%，高剂量使用者为68%；趋势P<0.005）。这也与两性的握力较低相关（趋势P：男性为0.012，女性为0.020），以及男性的瘦体重指数较低相关（趋势P为0.002）。然而，当前OCS剂量与这些结果无显著关联。
终生OCS暴露累积量与较高的衰弱和肌肉无力患病率相关。这些发现强调了尽量减少OCS终生暴露对延长哮喘患者健康预期寿命的重要性。
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