成人起病哮喘中未控制哮喘、合并症与生物标志物之间的相关性的年龄相关差异。

Age-related differences in associations between uncontrolled asthma, comorbidities and biomarkers in adult-onset asthma.

机构信息

The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

出版信息

J Asthma. 2023 Dec;60(12):2224-2232. doi: 10.1080/02770903.2023.2231078. Epub 2023 Jul 10.

DOI:10.1080/02770903.2023.2231078

PMID:37405375

Abstract

OBJECTIVE

Adult-onset asthma is a recognized but heterogeneous phenotype and has been described to associate with poor asthma control. Knowledge about associations between clinical characteristics including comorbidities and control of adult-onset asthma is limited, especially in older populations. We aimed to study how clinical biomarkers and comorbidities are associated with uncontrolled asthma among middle-aged and older individuals with adult-onset asthma.

METHODS

Clinical examinations including structured interview, asthma control test (ACT), spirometry, skin prick test (SPT), blood sampling, and measurement of exhaled fractional nitric oxide (FeNO) was performed in a population-based adult-onset asthma cohort in 2019-2020 ( = 227, 66.5% female). Analyses were performed among all included, and separately in middle-aged (37-64 years, = 120) and older (≥65 years, = 107) participants.

RESULTS

In bivariate analysis, uncontrolled asthma (ACT ≤ 19) was significantly associated with a blood neutrophil count ≥5/µl, BMI ≥30, and several comorbidities. In multivariable regression analysis, uncontrolled asthma was associated with neutrophils ≥5/µl (OR 2.35; 95% CI 1.11-4.99). In age-stratified analysis, BMI ≥30 (OR 3.04; 1.24-7.50), eosinophils ≥0.3/µl (OR 3.17; 1.20-8.37), neutrophils ≥5/µl (OR 4.39; 1.53-12.62) and allergic rhinitis (OR 5.10; 1.59-16.30) were associated with uncontrolled asthma among the middle-aged. Among the older adults, uncontrolled asthma was only associated with comorbidities: chronic rhinitis (OR 4.08; 1.62-10.31), ischemic heart disease (OR 3.59; 1.17-10.98), malignancy (OR 3.10; 1.10-8.73), and depression/anxiety (OR 16.31; 1.82-146.05).

CONCLUSIONS

In adult-onset asthma, comorbidities were strongly associated with uncontrolled asthma among older adults, while clinical biomarkers including eosinophils and neutrophils in blood were associated with uncontrolled asthma among middle-aged.

摘要

目的

成人起病哮喘是一种公认的但具有异质性的表型，并且与哮喘控制不佳有关。关于包括合并症在内的临床特征与成人起病哮喘的控制之间的关系的知识有限，尤其是在老年人群中。我们旨在研究在中年和老年的成人起病哮喘患者中，临床生物标志物和合并症与未控制的哮喘之间存在怎样的关联。

方法

在 2019-2020 年（共 227 名参与者，66.5%为女性）进行了一项基于人群的成人起病哮喘队列的临床检查，包括结构化访谈、哮喘控制测试（ACT）、肺活量测定、皮肤点刺试验（SPT）、血液采样和呼气中一氧化氮分数（FeNO）的测量。所有纳入的参与者都进行了分析，并且在中年（37-64 岁，n=120）和老年（≥65 岁，n=107）参与者中分别进行了分析。

结果

在单变量分析中，未控制的哮喘（ACT≤19）与血液中性粒细胞计数≥5/µl、BMI≥30 和几种合并症显著相关。在多变量回归分析中，未控制的哮喘与中性粒细胞计数≥5/µl（OR 2.35；95%CI 1.11-4.99）相关。在年龄分层分析中，BMI≥30（OR 3.04；1.24-7.50）、嗜酸性粒细胞计数≥0.3/µl（OR 3.17；1.20-8.37）、中性粒细胞计数≥5/µl（OR 4.39；1.53-12.62）和过敏性鼻炎（OR 5.10；1.59-16.30）与中年人群的未控制哮喘相关。在老年参与者中，未控制的哮喘仅与合并症相关：慢性鼻炎（OR 4.08；1.62-10.31）、缺血性心脏病（OR 3.59；1.17-10.98）、恶性肿瘤（OR 3.10；1.10-8.73）和抑郁/焦虑（OR 16.31；1.82-146.05）。