Characteristics of Late-onset Asthma in Elderly Asthmatic Patients

Abstract

Background: We evaluated the characteristics of late-onset asthma in elderly patients with asthma, particularly concerning the relationship of IgE mediation and response to treatment. Methods: This study included asthma patients aged 60 or older who were hospitalized under a clinical pathway that provided the treatment of asthma exacerbation, thorough examination, and patient education simultaneously. The patients were divided into two groups, those in whom asthma developed at age 60 or older (lateonset group) and those in whom asthma developed before age 60 (early-onset group). Both groups received step-down therapy with fluticasone dry powder after discharge, and asthma severity was compared between two time points: at 1 year and 2 years after the start of treatment. Results: One-third of all patients with asthma were aged 60 or older, and half of these had late-onset asthma. There was an inverse correlation between serum IgE levels and the age of onset. The positive rates of specific IgE antibodies to Japanese cedar pollen or house dust mite were significantly lower in the late-onset group than in the early-onset group. Pulmonary functions were equivalent between the two groups. However, asthma severity on admission was lower in the late-onset group. Response to treatment was better in the late-onset group, especially at 1 year of treatment. Conclusions: Asthma in elderly patients may be divided into early-onset persistent asthma and late-onset asthma with short duration. Late-onset asthma is less IgE-mediated, less severe, and has a better prognosis after appropriate treatment with inhaled fluticasone, and patients are more likely to drop out. For elderly patients with asthma, early detection, repetitive patient education and early intervention with inhaled corticosteroid therapy are important.

Keywords

• bronchial asthma
• clinical pathway
• elderly patient
• fluticasone
• IgE