High-resolution computed tomography findings in elderly patients with asthma

Objective: Based on the hypothesis that airway remodelling is related to the duration of asthma, HRCT scanning should show greater abnormalities in the early-onset than the late-onset asthmatics. It was, therefore, intended to assess the presence and the frequency of airway and parenchymal abnormalities with high-resolution computed tomography (HRCT) in elderly asthmatic patients, and to determine whether these abnormalities are related to the duration of asthma. Patients and methods: Sixty-eight clinically stable asthmatic patients aged >= 60 yr were included in this prospective study. The patients were separated into two groups according to the duration of symptoms as late-onset asthma (n = 3 1) with disease duration of < 5 yr, and early-onset asthma (n = 37) with disease duration of >= 5 yr. All patients were lifelong non-smoker and had been using inhaled beta agonists and inhaled steroids. HRCT-scanning and histamine inhalation test were performed on all patients. Results: In comparison with late-onset asthmatic patients, those with early-onset asthma had significantly higher frequency of emphysema (21.6% versus 0.0%, p=0.006), bronchial dilatation (13.9% versus 0.0%, p=0.03) and bronchial wall thickness (41.7% versus 12.9%, p=0.01). Multiple logistic regression analysis identified that early-onset of disease was an independent risk factor for the presence of irreversible HRCT-scan abnormalities in elderly asthmatics [odds ratio (OR): 9.4 (2.7-32.7),p=0.00001]. Conclusion: Present data suggest that HRCT abnormalities in early-onset elderly asthmatics reflect parenchymal and airway changes that become irreversible throughout the long course of the disease. (c) 2006 Elsevier Ireland Ltd. All rights reserved.