Abstract
Introduction: Asthma is a chronic inflammatory disorder of the airways. Adult onset asthma generally refers to the onset of asthma for the first time in some one of middle age or older. It is more common in females. It is postulated to be due to the effect of sex hormones in women. Studies have shown that women with adult onset asthma have increased risk of coronary heart disease and stroke. The aim of the study was to study the clinical profile and pulmonary function abnormalities in these patients, find out the aetiological factors for adult onset asthma in these patients and to know whether late onset asthma has any relation with coir industry which is a common industry in this area.
Materials and Methods: Fifty female patients presenting with episodic wheezing with the onset of symptoms after the age of 40 years were included in the study. A detailed history, physical examination, blood investigations including the absolute eosinophil count, chest radiography and pulmonary function tests were done in them. Skin tests were done only in those patients with history of allergy.
Observations: In our study majority of the patients were in the age group 40-49 and 50-59 years. Age of onset of symptoms was below 50 years for 46% of patients. 82% patients were living in costal ares.30 patients (60%) reported history of allergic rhinitis. Of the total 30 patients with allergic rhinitis, 46% had onset of asthma symptoms before 50 years of age and 80% of patients had asthma symptoms before 60 years. FEV1 values were analyzed in relation with age of patient and duration of symptoms and no correlation was found. FEV1 reversibility was less in coir workers compared to housewives. Patients in the older age group had lower PEF 25-75 values compared to those in the younger age group. Allergy testing was done in 10 patients, of this 4 patients were found to be sensitive to various allergens like house dust, wheat dust etc. All these 4 patients had allergic rhinitis.
Conclusions: Allergic symptoms are common in these patients and atopy may be a reason for development adult onset asthma. In women exposure to kitchen smoke could be an etiological factor for development of asthma. Adult onset asthma was found to be more common in workers in coir industry. FEV1 reversibility was less in coir workers compared to other occupational groups. Small air way dysfunction was more common in older age group patients with late onset asthma.
Keywords: Late onset asthma.
References
- de Nijs SB, Venekamp LN, Bel EH. Adult-onset asthma: is it really different?. European Respiratory Review. 2013 Mar 1;22(127):44-52
- Melgert BN, Ray A, Hylkema MN, Timens W, Postma DS. Are there reasons why adult asthma is more common in females?. Current allergy and asthma reports. 2007 Mar 1;7(2):143-50.
- Onufrak SJ, Abramson JL, Austin HD, Holguin F, McClellan WM, Vaccarino LV. Relation of adult-onset asthma to coronary heart disease and stroke. The American journal of cardiology. 2008 May 1;101(9):1247-52
- Amelink M, Nijs SB, Groot JC, Tilburg PM, Spiegel PI, Krouwels FH, Lutter R, Zwinderman AH, Weersink EJ, Brinke A, Sterk PJ. Three phenotypes of adult‐onset asthma. Allergy. 2013 May 1;68(5):674-80.
- Gilmour MI, Jaakkola MS, London SJ, Nel AE, Rogers CA. How exposure to environmental tobacco smoke, outdoor air pollutants, and increased pollen burdens influences the incidence of asthma. Environmental health perspectives. 2006 Apr;114(4):627.
- Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The Lancet. 2011 Jan 14;377(9760):139-46.
- LeVan TD, Koh WP, Lee HP, Koh D, Yu MC, London SJ. Vapor, dust, and smoke exposure in relation to adult-onset asthma and chronic respiratory symptoms: the Singapore Chinese Health Study. American journal of epidemiology. 2006 May 17;163(12):1118-28.
- Johnston SL, Martin RJ. Chlamydophila pneumoniae and Mycoplasma pneum-oniae: a role in asthma pathogenesis?. American journal of respiratory and critical care medicine. 2005 Nov 1;172(9):1078-89.
- Leone N, Courbon D, Berr C, Barbe-rger‐Gateau P, Tzourio C, Alpérovitch A, Zureik M. Abdominal Obesity and Late‐Onset Asthma: Cross‐Sectional and Longitudinal Results: The 3C Study. Obesity. 2012 Mar 1;20(3):628-35.
- Dykewicz MS. Occupational asthma: current concepts in pathogenesis, diagnosis, and management. Journal of Allergy and Clinical Immunology. 2009
- Ariano R, Panzani RC, Augeri G. Late onset asthma clinical and immunological data: importance of allergy. Journal of investigational allergology & clinical immunology. 1998;8(1):35-41.Mar 31;123(3):519-28.
- Thorn J, Brisman J, Toren K. Adult‐onset asthma is associated with self‐reported mold or environmental tobacco smoke exposures in the home. Allergy. 2001 Apr 1;56(4):287-92.
- Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent risk factor for adult-onset asthma. Journal of Allergy and Clinical Immunology. 2002 Mar 31;109(3):419-25.
- Panicker V, Karunakaran R, Ravindran C. Nasobronchial Allergy and Pulmonary Function Abnormalities Among Coir Workers of Alappuzha. JAPI. 2010 Jul;58:421.
Corresponding Author
Dr Ambili NR
Assistant Professor, Dept of Medicine, Govt TD Medical College,
Vandanam PO, Alappuzha 688005
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no: 9447248174
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.149
