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Clinical Investigations: ASTHMA |

Asthma in the Elderly*: Cockroach Sensitization and Severity of Airway Obstruction in Elderly Nonsmokers

Linda Rogers, MD, FCCP; Cara Cassino, MD, FCCP; Kenneth I. Berger, MD, FCCP; Roberta M. Goldring, MD; Robert G. Norman, MS; Thomas Klugh, RRT, MS; Joan Reibman, MD
Author and Funding Information

*From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY.

Correspondence to: Joan Reibman, MD, NYU Medical Center, Division of Pulmonary and Critical Care Medicine, 550 First Ave, New York, NY 10016; e-mail: reibmj01@gcrc.med.nyu.edu



Chest. 2002;122(5):1580-1586. doi:10.1378/chest.122.5.1580
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Study objectives: To test the hypothesis that the presence of sensitization to indoor allergens is associated with increased severity of airway obstruction in elderly subjects with asthma.

Design: Cohort study of subjects enrolled in a public hospital asthma clinic.

Setting: Asthma clinic in a municipal public hospital serving an indigent population in New York City.

Patients: Subjects aged ≥ 60 years with asthma who were enrolled in the Bellevue Hospital Asthma Clinic. Total serum IgE and allergen-specific IgE measurements were performed in a cohort of elderly never-smokers who had asthma (45 patients) who had undergone spirometry before and after bronchodilator (BD) therapy.

Measurements and results: The results of radioallergosorbent tests demonstrated that most subjects (ie, 60%) were sensitized to at least one allergen, with many sensitized to at least one indoor allergen. Cockroach (CR) was the most common allergen to which subjects were sensitized, with 47% displaying an elevated serum-specific IgE level. Fewer subjects were sensitized to dust mite, cat, dog, or ragweed. Subjects sensitized to CR (CR+) had greater reductions in airflow compared to subjects not sensitized to CR (CR−) [64 ± 4.4% predicted vs 77.1 ± 4.1% predicted FEV1, respectively; p < 0.05]. Following BD administration, only 29% of CR+ subjects achieved a normal post-BD FEV1 compared to 58% of CR− subjects. Lung volume measurements differed between CR+ and CR− subjects, with a greater elevation of functional residual capacity in CR+ subjects.

Conclusion: In a population of elderly urban patients with asthma, the presence of CR-specific serum IgE is associated with more severe asthma, as reflected by an increase in airway obstruction and hyperinflation.

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