Khosa Jaskiran K, Louie Samuel, Lobo Moreno Pamela, Abramov Dmitry, Rogstad Daniel K, Alismail Abdullah, Matus Michael J, Tan Laren D
Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA, USA.
Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
J Asthma Allergy. 2023 Jan 5;16:33-43. doi: 10.2147/JAA.S293081. eCollection 2023.
Uncontrolled asthma in the elderly is a public health issue recognized in developed countries such as the United States and among the European Union, both from patient safety and economic perspectives. Variations in the cutoff, which defines elderly age, contribute to epidemiological study difficulties. Nonetheless, the relevance of elderly asthma from a socioeconomic perspective is inarguable. The projected growth of the enlarging geriatric population in the United States portends an impending national health burden that may or may not be preventable with pharmacologic and non-pharmacologic treatments. Asthma in the elderly might be a consequence of uncontrolled disease that is carried throughout a lifetime. Or elderly asthmatics could suffer from uncontrolled asthma, which overlaps with other ailments common with advancing ages that merit consideration, eg, COPD, heart disease, OSA, diabetes mellitus, and other comorbidities. Because of the heterogeneity of asthma phenotypes and other conditions that could mimic the symptoms of elderly asthma, further cohort studies are needed to elucidate the elderly asthmatic pathophysiology and management. More studies to characterize elderly asthma can help address these patients' unmet need for evidence-based guidelines. We introduce the 5 "Ps" (phenotypes, partnership, pharmacology, practice in acute exacerbations, and problems or barriers for the elderly asthmatics) that establish a framework approach for clinical practice.
从患者安全和经济角度来看，老年人未得到控制的哮喘在美国和欧盟等发达国家都是一个公认的公共卫生问题。界定老年年龄的临界值存在差异，这给流行病学研究带来了困难。尽管如此，从社会经济角度来看，老年哮喘的相关性是无可争议的。美国老年人口预计会不断增长，这预示着即将出现全国性的健康负担，而药物和非药物治疗可能无法预防这种负担。老年人哮喘可能是一生未得到控制的疾病的后果。或者老年哮喘患者可能患有未得到控制的哮喘，这种哮喘与随着年龄增长而出现的其他常见疾病重叠，值得关注，例如慢性阻塞性肺疾病（COPD）、心脏病、阻塞性睡眠呼吸暂停（OSA）、糖尿病和其他合并症。由于哮喘表型的异质性以及其他可能模仿老年哮喘症状的病症，需要进一步开展队列研究以阐明老年哮喘的病理生理学和管理方法。更多旨在描述老年哮喘特征的研究有助于满足这些患者对循证指南的未满足需求。我们引入5个“P”（表型、伙伴关系、药理学、急性加重期的实践以及老年哮喘患者的问题或障碍），为临床实践建立一种框架方法。
