Poor asthma control and exposure to traffic pollutants and obesity in older adults
ABSTRACT Environmental and host predictors of asthma control in older asthmatic patients (>65 years old) are poorly understood.
To examine the effects of residential exposure to traffic exhaust and other environmental and host predictors on asthma control in older adults.
One hundred four asthmatic patients 65 years of age or older from allergy and pulmonary clinics in greater Cincinnati, Ohio, completed the validated Asthma Control Questionnaire (ACQ), pulmonary function testing, and skin prick testing to 10 common aeroallergens. Patients had a physician's diagnosis of asthma, had significant reversibility in forced expiratory volume in 1 second or a positive methacholine challenge test result, and did not have chronic obstructive pulmonary disease. The mean daily residential exposure to elemental carbon attributable to traffic (ECAT) was estimated using a land-use regression model. Regression models were used to evaluate associations among independent variables, ACQ scores, and the number of asthma exacerbations, defined as acute worsening of asthma symptoms requiring prednisone use, in the past year.
In the adjusted model, mean daily residential exposure to ECAT greater than 0.39 μg/m(3) was significantly associated with poorer asthma control based on ACQ scores (adjusted β = 2.85; 95% confidence interval [CI], 0.58-5.12; P = .02). High ECAT levels were also significantly associated with increased risk of asthma exacerbations (adjusted odds ratio, 3.24; 95% CI, 1.01-10.37; P = .05). A significant association was found between higher body mass index and worse ACQ scores (adjusted β = 1.15; 95% CI, 0.53-1.76; P < .001). Atopic patients (skin prick test positive) had significantly better ACQ scores than nonatopic patients (adjusted β = -0.39; 95% CI, -0.67 to -0.11; P < .01).
Higher mean daily residential exposure to traffic exhaust, obesity, and nonatopic status are associated with poorer asthma control among older asthmatic patients.
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ABSTRACT: Lung function successfully predicts subsequent health. Although lung function is known to decline over age, little is known about changes in association with socioeconomic status (SES) throughout life, and whether explanatory factors for association vary with age or patterns for non smokers. Analyses were based on data on 24 500 participants aged ≥18 years from the 1995, 1998 and 2003 Scottish Health Surveys who were invited to provide 1 s forced expiratory volume (FEV1) and forced vital capacity (FVC) lung measurements. Sex-stratified multiple linear regression assessed lung function-SES (occupational social class) associations and attenuation by covariates in three age groups (2003 data (n=7928)). The FEV1-SES patterns were clear (p<0.001) and constant over time. Relative to the least disadvantaged, FEV1 in the most disadvantaged was lower by 0.28 L in men and 0.20 L in women under 40 years compared with differences of 0.51 L in men and 0.25 L in women over 64 years (pinteraction<0.001 men, pinteraction=0.004 women). The greatest attenuation of these results was seen by height, parental social class and smoking, especially among the under 65s. Second-hand smoke exposure and urban/rural residence had some impact among older groups. Adjusting for physical activity and weight had little effect generally. Similar patterns were seen for FVC and among never smokers. We found cross-sectional evidence that SES disparity in lung function increases with age, especially for men. Our findings indicate that early-life factors may predict inequity during younger adulthood, with environmental factors becoming more important at older ages.Journal of epidemiology and community health 08/2013; 67(11). DOI:10.1136/jech-2012-201704 · 3.29 Impact Factor
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ABSTRACT: Abstract Objective: Airway inflammatory patterns in older asthmatics are poorly understood despite high asthma-related morbidity and mortality. In this study, we sought to define the relationship between exposure to traffic pollutants, biomarkers in induced sputum, and asthma control in older adults. Methods: Induced sputum was collected from 35 non-smoking adults ≥ 65 years with a physician's diagnosis of asthma and reversibility with a bronchodilator or a positive methacholine challenge. Patients completed the Asthma Control Questionnaire (ACQ), and Elemental Carbon Attributable to Traffic (ECAT), a surrogate for chronic diesel particulate exposure, was determined. Equal numbers of subjects with high (≥0.39 µg/m(3)) versus low (<0.39 µg/m(3)) ECAT were included. Differential cell counts were performed on induced sputum, and myeloperoxidase (MPO) and eosinophil peroxidase (EPO) were measured in supernatants. Regression analyses were used to evaluate the relationship between sputum findings, ACQ scores, and ECAT. Results: After adjustment for potential confounders, subjects with poorly controlled asthma based on ACQ ≥1.5 (n=7) had significantly higher sputum eosinophils (median=4.4%) than those with ACQ <1.5 (n=28; eosinophils=2.6%; β=10.1 [95% CI=0.1-21.0]; p=0.05). Subjects with ACQ ≥1.5 also had significantly higher sputum neutrophils (84.2% versus 65.2%; β=7.1 [0.2-14.6]; p=0.05). Poorly controlled asthma was associated with higher sputum EPO (β= 2.4 [0.2-4.5], p=0.04), but not MPO (p=0.9). High ECAT was associated with higher eosinophils (β= 10.1 [1.8-18.4], p=0.02) but not higher neutrophils (p=0.6). Conclusions: Poorly controlled asthma in older adults is associated with eosinophilic and neutrophilic inflammation. Chronic residential traffic pollution exposure may be associated with eosinophilic, but not neutrophilic inflammation in older asthmatics.Journal of Asthma 08/2013; 50(9). DOI:10.3109/02770903.2013.832293 · 1.83 Impact Factor
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ABSTRACT: There is a growing allergy problem in elderly patients. The epidemiology of atopic bronchial asthma (BA), allergic rhinitis, and atopic dermatitis (AD) was analyzed in an elderly Polish population. Subject recruitment was conducted at 16 sites representative of Polish rural and urban areas, and 7124 subjects, including 4176 women with a mean age of 67.5 ± 84.9 years and 2948 men with a mean age of 66.1 ± 7.2 years, were screened. Medical examinations, an original questionnaire, skin-prick testing (SPT) with common aeroallergens, and appropriate serum-specific IgE assays were performed. Suspicion of atopy was diagnosed in 1900 of the 7124 analyzed patients (26.7%), including 1117 women (26.7% of women) and 783 men (26.6% of men). The average morbidity associated with age and sex in this population was 5.9% (95% CI, 5.1-6.4) for BA, 1.6% (95% CI, 15.9-19.3) for AD/eczema, 12.6% (95% CI, 10.8-14.6) for seasonal allergic rhinitis, 17.1% (95% CI, 15.9-19.7) for perennial allergic rhinitis, and 6.4% (95% CI, 5.1-7.3) for polymorphous atopic disease. The most frequent positive results were recorded for the following allergens: mixed grass, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Alternaria. This study confirms the high prevalence of allergic rhinitis and BA in elderly Polish patients. These findings are comparable with those involving groups of younger individuals with allergies.American Journal of Rhinology and Allergy 09/2013; 27(5):140-145. DOI:10.2500/ajra.2013.27.3920 · 2.18 Impact Factor