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- Title
Longitudinal Changes in Clinical Outcomes in Older Patients with Asthma, COPD and Asthma-COPD Overlap Syndrome.
- Authors
Fu, Juan-juan; Gibson, Peter G.; Simpson, Jodie L.; McDonald, Vanessa M.
- 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 FEV1 (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
- 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
- Publication
Respiration, 2014, Vol 87, Issue 1, p63
- ISSN
0025-7931
- Publication type
Article
- DOI
10.1159/000352053