- Title
- Longitudinal changes in clinical outcomes in older patients with asthma, COPD and asthma-COPD overlap syndrome
- Creator
- Fu, Juan J.; Gibson, Peter G.; Simpson, Jodie L.; McDonald, Vanessa M.
- Relation
- Respiration Vol. 87, Issue 1, p. 63-74
- Publisher Link
- http://dx.doi.org/10.1159/000352053
- Publisher
- S. Karger AG
- Resource Type
- journal article
- Date
- 2014
- Description
- 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.
- Subject
- asthma; asthma-COPD overlap; chronic obstructive pulmonary disease; longitudinal changes; multidimensional assessment; obstructive airway disease
- Identifier
- http://hdl.handle.net/1959.13/1295789
- Identifier
- uon:19123
- Identifier
- ISSN:0025-7931
- Language
- eng
- Reviewed
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