Characterization and cluster analyses of elderly asthma in comparison with nonelderly patients with asthma in Japan

Maho Suzukawa; Ken Ohta; Hiroya Hashimoto; Yoshitaka Oyamada; Mari Miki; Mitsumasa Ogawara; Yoshikazu Inoue; Akiko M Saito; Yuma Fukutomi; Nobuyuki Kobayashi; Masami Taniguchi; NHOM-Asthma Study Group

doi:10.1016/j.anai.2023.01.003

Characterization and cluster analyses of elderly asthma in comparison with nonelderly patients with asthma in Japan

Ann Allergy Asthma Immunol. 2023 May;130(5):607-616.e3. doi: 10.1016/j.anai.2023.01.003. Epub 2023 Jan 16.

Authors

Affiliations

¹ Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: fueta-tky@umin.ac.jp.
² Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Japan Anti-Tuberculosis Association, JATA Fukujuji Hospital, Tokyo, Japan.
³ Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
⁴ National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
⁵ Tokushima Prefecture Naruto Hospital, Tokushima, Japan.
⁶ National Hospital Organization Osaka National Hospital, Osaka, Japan.
⁷ National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
⁸ Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
⁹ Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
¹⁰ Fureai Machida Hospital, Tokyo, Japan.
¹¹ Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Shonan Kamakura General Hospital, Kanagawa, Japan.

PMID: 36657562
DOI: 10.1016/j.anai.2023.01.003

Abstract

Background: Asthma is a heterogeneous disease with multiple phenotypes that are useful in precision medicine. As the population ages, the elderly asthma (EA, aged ≥ 65 years) population is growing, and EA is now a major health problem worldwide.

Objective: To characterize EA and identify its phenotypes.

Methods: In adult patients with asthma (aged ≥ 18 years) who had been diagnosed with having asthma at least 1 year before study enrollment, 1925 were included in the NHOM-Asthma (registered in UMIN-CTR; UMIN000027776), and the data were used for this study, JFGE-Asthma (registered in UMIN-CTR; UMIN000036912). Data from EA and non-EA (NEA) groups were compared, and Ward's minimum-variance hierarchical clustering method and principal component analysis were performed.

Results: EA was characterized by older asthma onset, longer asthma duration and smoking history, more comorbidities, lower pulmonary function, less atopic, lower adherence, and more hospital admissions because of asthma. In contrast, the number of eosinophils, total immunoglobulin E level, oral corticosteroid use, and asthma control questionnaire scores were equivalent between EA and NEA. There were 3 distinct phenotypes in EA, which are as follows: EA1: youngest, late onset, short duration, mild; EA2: early onset, long duration, atopic, low lung function, moderate; and EA3: oldest, eosinophilic, overweight, low lung function, most severe. The classification factors of the EA phenotypes included the age of onset and asthma control questionnaire-6. Similarities were observed between EA and NEA phenotypes after principal component analysis.

Conclusion: The EA in Japan may be unique because of the population's high longevity. Characterization of EA phenotypes from the present cohort indicated the need for distinct precision medicine for EA.

Trial registration: JFGE-Asthma registered in UMIN-CTR (https://www.umin.ac.jp/ctr/); UMIN000036912.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asthma*
Cluster Analysis
Eosinophils
Humans
Japan / epidemiology
Lung
Phenotype

Associated data

JPRN/UMIN000036912