Phenotypes of Obstructive Lung Diseases in Elderly: A Real-Life Study in a Non-Clinical Setting

Abstract Background: This study aimed to characterize the clinical, functional, inflammatory and immunological features of the main obstructive lung diseases (OLD) in elderly. Methods: We included subjects aged ≥ 65 years. In Phase I, participants answered standardized questionnaires, performed spirometry, fractional exhaled nitric oxide, an atopy assessment and blood analysis. In Phase II, patients with COPD or asthma criteria and a control group were invited to undergo a more detailed evaluation that included the determination of IL-1-β, IL-5, IL-6, IL-13, TNF-α and periostin. In Phase III was assessed the frequency of non-scheduled medical visits due to respiratory exacerbations, hospitalization and mortality. Results: Phase I included 286 participants. The median age was 85.8 (P27-P75: 81.0 - 90.2) years and 69% were females: 27.3% had chronic obstructive pulmonary disease (COPD) without asthma (Group 1), 2.8% asthma without COPD (Group 2) and 5.2% presented asthma and COPD traits (Group 3). The remaining participants (64.7%), without asthma or COPD, were classified as Group 4. At this stage, Group 3 was more atopic and presented a lower post-bronchodilator FEV 1 and FEV 1 /FVC. In Phase II, that included 82 participants, Group 3 presented the higher median values of TNF-α (p-value: 0.072) and higher lung volumes (p=0.001). No statistically differences were found for other cytokines among groups. In Phase III, Group 3 patients needed more non-scheduled visits. Conclusions: In our study patients with asthma and COPD traits presented more severe airflow limitation, higher values of TNF-α, higher lung volumes and more non-scheduled medical visits.