Atopy and Bronchial Hyper-Responsiveness Relative to Lung Function in Young and Elderly Asthma Patients

年輕與老年氣喘病人的肺功能與過敏和支氣管過反應的相關性

曾敬閔(Ching-Min Tseng) ； 蕭逸函(Yi-Han Hsiao) ； 蘇剛正(Kang-Cheng Su) ； 陶啟偉(Chi-Wei Tao) ； 彭殿王(Diahn-Warng Perng) ； 陳美音(Mei-Yin Chen)

《胸腔醫學》 33卷3期 (2018/06) Pp. 95-105

摘要

Background: The prevalence of asthma among the elderly is increasing and the incidence of mortality and morbidity in this group is higher than that of young asthmatics. However, the clinical differences between younger and older patients with asthma have not been totally clarified. Methods: In this retrospective, hospital-based study, 992 asthmatic patients who were newly diagnosed and untreated at the outpatient clinic were recruited and placed into one of two groups based on age: a younger (32.4±7.7 years, n=476) and an older (75.2±7.7 years, n=516) group. Data on lung function, smoking history, atopy (defined as having a positive serum allergen immunoassay), methacholine provocation test (MCT), bronchodilator test (BDT), and serum IgE level were obtained. Results: The prevalence of allergic rhinitis, atopic status and higher serum IgE levels was lower in the older group than in the younger group of asthmatics, but the prevalence of positive MCT (79.2% vs 76.1%) and BDT (55.2% vs 56.2%) in the older group was similar to that of the younger group. Patients with a positive MCT had a poor forced expiratory volume in 1 second predicted value (FEV1%); atopy (OR: 2.048, p=0.002) and FEV1% (OR: 0.978, p=0.001) were associated with positive MCT. Elderly atopic asthmatics had worse FEV1 than elderly non-atopic asthmatics (70.3% vs 77.6%). However, young atopic asthmatics had better FEV1% than young non-atopic asthmatics. Young atopic asthmatics had a higher prevalence of positive MCT than young non-atopic asthmatics (p=0.002). Conclusions: Our results revealed differences in clinical characteristics between younger and older asthmatic patients.

關鍵字

atopy ； bronchial hyper-responsiveness ； asthma ； elderly

並列摘要

前言：老年氣喘病的盛行率近幾年逐年增加，其併發症與死亡率也相對上升，目前對於此兩個族群是否有不同的氣喘特徵仍不是相當清楚。方法：這是一個單一中心、回溯性的研究，收集共九百九十二位在胸腔內科門診新診斷且未治療過氣喘的病人，分析包括肺功能、抽菸史、過敏史、氣管激發試驗（methacholine test）、支氣管擴張測驗（bronchodilator test）以及血漿E 型抗體濃度等數據做為比較。結果：年輕的氣喘病人共476 人，平均為32.4±7.7 歲，而516 位年老氣喘病人平均為75.2±7.7 歲，在過敏史方面，過敏性鼻炎、過敏體質、以及血中E 型抗體濃度在年老氣喘病人比例比較低；年老氣喘病人和年輕氣喘病人在支氣管激發試驗（79.2% vs 76.1%）和支氣管擴張反應（55.2% vs 56.2%）的比例無差別，有過敏體質（OR: 2.048, p=0.002）或是第一秒用力吐氣量（OR: 0.978, p=0.001）與支氣管激發試驗陽性的病人有相關性；年老又有過敏體質的氣喘病人比起年老無過敏體質的病人其第一秒用力吐氣量較差（70.3% vs 77.6%），而年輕有過敏的氣喘病人比起沒有過敏的年輕氣喘病人肺功能反而比較好。結論：我們發現年輕與年老氣喘病人在過敏與肺功能相關檢查的不同特色，可以幫助我們更了解年紀不同的氣喘特色。

並列關鍵字

過敏 ； 支氣管過反應 ； 氣喘 ； 老年人