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Study Suggests Cockroach Sensitization Linked To Asthma Morbidity in Urban Elderly; Elderly Sensitized to Cockroach Allergens Experience Increased Airway Obstruction and Hyperinflation.

NORTHBROOK, Ill. -- Cockroach (CR) allergens may play a significant role in urban asthma morbidity, particularly among the elderly. A study conducted at the New York University School of Medicine found that urban elderly with asthma were most commonly sensitized to CR allergens and that CR sensitization was associated with increased airflow limitation, hyperinflation, and irreversible airway obstruction.

The study, published in the November edition of CHEST, the peer-reviewed journal of the American College of Chest Physicians, investigated the relationship between allergen sensitization and increased severity of airway obstruction in 45 urban, non-smoking patients, age 60 or older, who were physician-diagnosed with asthma.

"Research has shown cockroach as the most significant allergen in children and adults with asthma. However, there is very little known about asthma and the elderly," said lead study author Linda Rogers, MD, FCCP, Assistant Professor of Medicine at New York University School of Medicine and Attending Physician at Bellevue Hospital Asthma Clinic. "This study suggests that cockroach is a highly significant allergen to all age groups."

Patients' sensitizations to total indoor and outdoor allergens were identified through radioallergosorbent testing (RAST). Results indicated that 53 percent of patients were sensitized to at least one indoor allergen, while 20 percent were sensitized to at least one outdoor allergen. Results showed that CR was the most common indoor allergen to which 47 percent of patients were sensitized. Physicians compared RAST results to patients' pulmonary function and found that patients sensitized to indoor allergens had decreased pulmonary function. No relationship was found between pulmonary function and outdoor allergen sensitization.

Spirometry and plethysmography tests were used to determine the association between pulmonary function and patients' sensitivity to CR allergens. Results showed that airflow, as measured by forced expiratory air volume, was significantly lower in patients with CR sensitivity (CR+) as compared to patients without CR sensitivity (CR-). In addition, CR+ patients had a greater elevation in functional residual capacity and residual volume.

To determine airflow recovery, patient response to bronchodilator (BD) administration was evaluated. CR+ and CR- patients showed a similar degree of improvement following BD administration. However, CR- patients achieved a normal post-BD level, while CR+ patients demonstrated persistent airway obstruction.

Patients who had been enrolled in the Bellevue Hospital Asthma Clinic in urban New York between 1991 and 1998, were evaluated for entry into the study. Of the 114 patients eligible to participate, 92 patients completed spirometry testing and 45 patients completed all necessary testing.

"This study reinforces the need for consistent monitoring and care for elderly with asthma," said Richard S. Irwin, MD, FCCP, president-elect of the American College of Chest Physicians. "By knowing which allergens older patients are most sensitized, as clinicians, we can offer more effective asthma treatments and advise them on appropriate lifestyle modifications."

CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at http://www.chestjournal.org/ . ACCP represents more than 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research and communication.

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CONTACT: Liza Morris, +1-202-955-6222, or lmorris@spectrumscience.com, for American College of Chest Physicians, or Jennifer Stawarz of American College of Chest Physicians, +1-847-498-8306, or jstawarz@chestnet.org

Web site: http://www.chestjournal.org/
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Date:Nov 12, 2002
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