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Longitudinal Changes in Clinical Outcomes in Older Patients with Asthma, COPD and Asthma-COPD Overlap Syndrome.
- Source :
- Respiration; Jan2014, Vol. 87 Issue 1, p63-74, 12p, 5 Charts, 4 Graphs
- Publication Year :
- 2014
-
Abstract
- Background: The progression of obstructive airway diseases (OADs) including asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome in older adults is not well understood. Objective: To examine the prognosis of OADs and to identify potential determinants for longitudinal changes in clinical outcomes. Methods: We consecutively recruited 99 older adults (>55 years) with OADs who underwent a multidimensional assessment at baseline and 4 years which involved spirometry, 6-min walk distance (6MWD), assessments of health status (Saint George's Respiratory Questionnaire, SGRQ), comorbidity, and serum and sputum biomarkers. All-cause mortality and respiratory hospitalisation during the follow-up period were recorded. Clinical outcomes were compared between basal and final visits, and changes in clinical outcomes were compared among asthma, COPD and asthma-COPD overlap groups. Associations between clinical parameters, biomarkers and prognosis were examined. Results: After a median follow-up of 4.2 years, outcome data were available for 75 (75.8%) patients. There were 16 (16.2%) deaths. The BODE index predicted all-cause mortality in older people with OADs. While spirometry, 6MWD and SGRQ deteriorated significantly over the 4 years, there was significant heterogeneity in the longitudinal changes in these clinical outcomes. Participants with COPD had a significant decline in FEV<subscript>1</subscript> (p = 0.003), SGRQ (p = 0.030) and 6MWD [decline of 75.5 (93.4) m, p = 0.024]. The change in 6MWD was lower in the asthma-COPD overlap group. Airflow reversibility was associated with a reduced decline in 6MWD. Conclusion: COPD patients had a poor prognosis compared with asthma and asthma-COPD overlap patients. The BODE index is a useful prognostic indicator in older adults with OADs. Both airway disease diagnosis and BODE index warrant specific attention in clinical practice. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Subjects :
- OBSTRUCTIVE lung diseases
ASTHMA
BIOMARKERS
ENZYME-linked immunosorbent assay
FISHER exact test
LONGITUDINAL method
EVALUATION of medical care
MORTALITY
QUESTIONNAIRES
REGRESSION analysis
SPIROMETRY
SPUTUM
STATISTICS
SURVIVAL analysis (Biometry)
T-test (Statistics)
COMORBIDITY
DATA analysis
PRE-tests & post-tests
DISEASE progression
DATA analysis software
DESCRIPTIVE statistics
PROGNOSIS
Subjects
Details
- Language :
- English
- ISSN :
- 00257931
- Volume :
- 87
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Respiration
- Publication Type :
- Academic Journal
- Accession number :
- 94232393
- Full Text :
- https://doi.org/10.1159/000352053