Allergy Asthma Immunol Res.  2017 Jul;9(4):378-382. 10.4168/aair.2017.9.4.378.

Plasma LTE₄/PGF₂α Ratio and Blood Eosinophil Count Are Increased in Elderly Asthmatics With Previous Asthma Exacerbation

• Ban GY
• Ye YM
• Kim SH
• Hur GY
• Kim JH
• Shim JJ
• Cho K
• Cho JY
• Park HS
• PRANA group

• KMID: 2378202
• DOI: http://doi.org/10.4168/aair.2017.9.4.378

Abstract

The tools for asthma control assessment recommended by the current guideline are cognitive function- and effort-dependent, which is substantially impaired in the elderly. The aim of this study is to investigate objective assessment tools of asthma control status and previous asthma exacerbation (AE) in elderly subjects. Asthmatics aged >60 years who were treated with step 2 or 3 by the Global Initiative for Asthma (GINA) guideline were enrolled. During the 12-week study period, the subjects used either 400 µg of budesonide plus 10 mg of montelukast or 800 µg of inhaled budesonide. The occurrence of AE during the 4-week run-in and 12-week treatment period was monitored. After 12-week of treatment, sputum eosinophil count, peripheral eosinophil count, the plasma leukotriene Eâ‚„ (LTEâ‚„), and prostaglandin F₂α (PGF₂α) metabolite levels were measured using the UHPLC/Q-ToF MS system. The study subjects were divided into group 1 (asthmatics who experienced AE during the study period) and group 2 (those who did not). A total of 101 patients aged 60-85 years were enrolled. Twenty-three patients (22.8%) had experienced AE. The plasma LTEâ‚„ level, LTEâ‚„/PGF₂α ratio, and peripheral eosinophil count were significantly higher in group 1 than in group 2 (P=0.023, P=0.010, P=0.033, respectively). The plasma LTEâ‚„/PGF₂α ratio and peripheral eosinophil count at week 12 were significantly associated with previous AE (odds ratio [OR]=1.748, P=0.013; OR=1.256, P=0.027). Receiver operating characteristic (ROC) curves to discriminate the subjects with previous AE, including these 2 parameters, showed that the area under the curve was 0.700 (P=0.004), with 73.9% sensitivity and 47.9% specificity. In conclusion, a combination of plasma LTEâ‚„/PGF₂α ratio and peripheral eosinophil count can be an objective assessment tool which is significantly associated with asthma control status in elderly asthmatics.

Keyword

Elderly asthma; exacerbation; leukotriene

MeSH Terms

Aged*
Asthma*
Budesonide
Eosinophils*
Humans
Plasma*
ROC Curve
Sensitivity and Specificity
Sputum
Budesonide

Figure

• 

  Figure Comparison of the plasma levels of LTE4 (A) and PGF2α, (B) and LTE4/PGF2α ratio according to the presence of previous AE (C). The plasma LTE4 level and LTE4/PGF2α ratio were significantly higher in group 1 than in group 2 (P=0.023 and P=0.010, respectively). Data were analyzed by general linear regression analysis adjusted for age, gender, and type of anti-asthmatics treatment. Group 1: patients who experienced AE for previous 12 weeks, Group 2: patients who that did not experience AE for previous 12 weeks. AE, asthma exacerbation; LTE4, leukotriene E4; PGF2α, prostaglandin F2α.

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