General Risk Factors and Inflammatory Determinants in Older Patients With Asthma
General Risk Factors and Inflammatory Determinants in Older Patients With Asthma
A cross-sectional study in asthma patients to determine if a late age of onset asthma (start
 symptoms >18 years old), is associated with more persistent airway/systemic inflammation,
 worse asthma control, more co-morbidity, a different microbiome and poorer quality of life
 despite the use of optimized asthma therapy.
For ages, asthma has been considered a disease for children and young adults. However,
 nowadays 30% of all asthma patients is over 50 years old. Asthma in the elderly is generally
 more severe and approximately 50% of all deaths drom asthma occur in this age group. With
 rapid aging of the global population, the burden of asthma in the elderly will further
 increase.

 Asthma is a heterogeneous disease and the question is whether asthma in the elderly can be
 considered the same disease as asthma in children and young adults. The pathophysiology and
 risk factors of asthma in the elderly are still not completely understood. Good
 characterization of asthma in the elderly requires clinical phenotyping as well as a thorough
 analysis of the underlying cellular and molecular mechanisms. It is hypothesized that in
 older asthma patients, a late age of onset (start asthma symptoms >18 years) is associated
 with more persistent airway/systemic inflammation, worse asthma control, more co-morbidity
 and poorer quality of life despite the use of optimized asthma therapy.
Inclusion Criteria Asthma patients:

 -  Age between 18-80 years

 -  Smoking history of < 10 packyears (PY)

 -  Willing and able to comply with the study protocol

 -  Asthma diagnosis is based on presence of typical clinical symptoms, reversible airway
 obstruction (+12% improvement in forced expiratory volume at one second (FEV1) after
 bronchodilator) or bronchial hyperreactivity (PC20 < 8 mg/ml) or a (fractional exhaled
 nitric oxide) FeNO > 50 ppb. - All asthma patients have (Global Initiative for Asthma
 ) GINA step 4-5 medication (high dose ICS/LABA).

 -  Asthma control questionaire (ACQ) > 0,75

 -  Written informed consent.

 Inclusion Criteria Healthy controls:\Inclusion criteria healthy control:

 -  Written informed consent

 -  Age between 18-80 years.

 Exclusion Criteria:

 -  Smoking history of > 10 PY

 -  Age < 18 years or > 80 years

 -  Not able to speak or write Dutch language.

 -  Not able to perform lung function test/sputum induction

 -  ACQ < 0,75

 -  Other diseases which could influence pulmonary function and/or the immune system such
 as: o A possible infection of the upper- or lower respiratory tract 4 weeks prior to
 the collection of materials;

 -  Chronic obstructive pulmonary disorder (COPD) in the medical history;

 -  Auto-immune diseases such as systemic lupus erythematosus (SLE), rheumatoid
 arthritis (RA), myasthenia gravis or Goodpasture's syndrome;

 -  Malignancies;

 -  Inherited or acquired immunodeficiency

 -  Pregnancy;

 Exclusion criteria healthy controls:

 -  Asthma, as defined earlier (page 13);

 -  An abnormal spirometry with a forced vital capacity (FVC) or FEV1 below the 80% of the
 predicted value

 -  A liaison with the coordinating or principal investigator, which could likely
 influence the decision to participate in this study voluntarily (in concordance with
 the World Meteorological Organization (WMO) -article 5);