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Effect of Age Upon Airway Obstruction and Reversibility in Adult Patients With Asthma FREE TO VIEW

Vincenzo Bellia; Fabio Cibella; Giuseppina Cuttitta; Nicola Scichilone; Gianfranco Mancuso; Antonio M. Vignola; Giovanni Bonsignore
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From the Istituto di Fisiopatologia Respiratoria del C.N.R. and Istituto di Pneumologia dell'Università, Palermo, Italy

Vincenzo Bellia, MD, Clinica Pneumologica dell'Università, via Trabucco 180, 90146 Palermo, Italy

1998 by the American College of Chest Physicians

Chest. 1998;114(5):1336-1342. doi:10.1378/chest.114.5.1336
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Objective: In a cross-sectional study we evaluated the effect of aging (separately from that of duration of disease) on airway obstruction and reversibility by comparing two groups of non-smoker patients with asthma.

Methods: We compared two groups of patients: group A, which had 50 subjects (8 men and 42 women) aged 59.7 ± 4.6 years (mean ± SD), and group B, comprised of 51 subjects (19 men and 32 women) who were 35.7 ± 7.4 years old. The groups were selected because of comparable baseline degree of obstruction (FEV1 % of predicted, 67.8 ± 20.3 in group A; 73.0 ± 19.6 in group B, NS) and duration of the disease (14.0 ± 11.7 years vs 11.2 ± 9.1, NS). Spirometric examination, with a bronchodilator test, was performed and subjects not reaching 85% of predicted were submitted to a 4-week course of inhaled steroids.

Results: Although a higher number of subjects from group B responded to the acute bronchodilator test (p < 0.001), the maximum response achievable with treatment (steroid or bronchodilator) (ΔFEV1 expressed as the percent of predicted) was not statistically different between groups (12.0 ± 17.5 vs 16.0 ± 23.9). The mean FEV1 attainable after treatment ΔFEV1 PT) was significantly lower in the older group (p = 0.0006). Within groups, the baseline FEV1% did not correlate with age; it was inversely correlated with the duration of the disease (p < 0.03 and p < 0.01, respectively). In both groups ΔFEV1 was inversely related with the baseline FEV1 whereas FEV1 %PT was correlated with the duration of the disease, with a slope nearly doubled in group B (p < 0.001).

Conclusions: Both the process of aging and the prolonged exposure to disease effects are important factors in determining the functional characteristics of chronic asthma: In particular, aging is associated not only with a reduced acute responsiveness to bronchodilators, but also with a reduced slope of the duration-FEV1%PT relationship that suggests a slowing of the rate of loss of reversibility of uncertain biological meaning.




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