The following is a summary of the “Age-Related Clinical Characteristics, Inflammatory Features, Phenotypes, and Treatment Response in Asthma,” published in the January 2023 issue of Allergy and Clinical Immunology by Wang, et al. 

This study aims to understand better how aging affects asthma by examining its clinical characteristics, inflammatory aspects, phenotypes, and responsiveness to treatment. Patients with asthma were followed for 12 months in this prospective cohort research. 

Age-related differences in clinical inflammation and phenotypic features, the risk for exacerbations in the future, and treatment responsiveness were evaluated (young was defined as age 18 to 39 years; middle-aged, 40 to 64 years; and elderly, 65 years or older).

Compared with young (n = 106) and middle-aged (n = 179) asthmatic patients, elderly patients (n = 55) had worse airway obstruction, more comorbidities including chronic obstructive pulmonary disease and diabetes, less atopy, and lower levels of IgE and FeNO, and were more likely to have late-onset and fixed airflow obstruction asthma and a reduced risk for having type 2 profile asthma. In older individuals with asthma, there were statistically significant increases in induced sputum levels of IFN-gamma, IL-17A, and IL-8. 

The elevation of airway IFN-gamma by increasing age was found to be a direct and important pathway from aging to future asthma exacerbations. Moreover, the treatment response of older patients (all P < .05) with asthma was poorer (improvement in FEV1 of 12% or more, or 200 mL; reduction in Borg scores of 1 or more; adjusted odds ratio = 0.11; 95% CI, 0.02-0.52; and adjusted odds ratio = 0.12; 95% CI, 0.03-0.49, respectively). This study provides evidence that asthma in the older population reflects a distinct phenotype and that aging can affect asthma in terms of clinical aspects, inflammatory characteristics, exacerbations, and treatment responsiveness.