Allergic diseases in the elderly

Demographic distribution of the population is progressively changing with the proportion of elderly persons increasing in most societies. This entails that there is a need to evaluate the impact of common diseases, such as asthma and other allergic conditions, in this age segment. Frailty, comorbidities and polymedication are some of the factors that condition management in geriatric patients. The objective of this review is to highlight the characteristics of allergic diseases in older age groups, from the influence of immunosenescence, to particular clinical implications and management issues, such as drug interactions or age-related side effects

A meta-analysis of adverse perinatal outcomes in women with asthma

Background: Asthma is a common condition during pregnancy and may be associated with adverse perinatal outcomes. Objective: This meta-analysis sought to establish if maternal asthma is associated with an increased risk of adverse perinatal outcomes, and to determine the size of these effects. Search strategy: Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Selection criteria: Cohort studies published between 1975 and March 2009 were considered for inclusion. Studies were included if they reported at least one perinatal outcome in pregnant women with and without asthma. Data collection and analysis: A total of 103 articles were identified, and of these 40 publications involving 1 637 180 subjects were included. Meta-analysis was conducted with subgroup analyses by study design and active asthma management. Main results: Maternal asthma was associated with an increased risk of low birthweight (RR 1.46, 95% CI 1.22–1.75), small for gestational age (RR 1.22, 95% CI 1.14–1.31), preterm delivery (RR 1.41, 95% CI 1.22–1.61) and pre-eclampsia (RR 1.54, 95% CI 1.32–1.81). The relative risk of preterm delivery and preterm labour were reduced to non-significant levels by active asthma management (RR 1.07, 95% CI 0.91–1.26 for preterm delivery; RR 0.96, 95% CI 0.73–1.26 for preterm labour). Author’s conclusions: Pregnant women with asthma are at increased risk of perinatal complications, including pre-eclampsia and outcomes that affect the baby’s size and timing of birth. Active asthma management with a view to reducing the exacerbation rate may be clinically useful in reducing the risk of perinatal complications, particularly preterm delivery

Severity of asthma in pregnancy affects perinatal outcomes: Authors' Reply

We read with great interest the recent review on adverse perinatal outcomes in women with asthma by Murphy et al. Maternal asthma is a potentially dangerous reversible anoxigenic condition, which adversely affects perinatal outcomes. The most important factor affecting perinatal outcome is the severity and control of asthma. Earlier studies reported that prematurity, low birthweight, fetal growth restriction and even perinatal deaths were more frequent in pregnant women with asthma. In our experience, mild asthma during pregnancy had no significant effect on fetal growth, as evidenced by a normal mean birthweight. In contrast, severe maternal asthma requiring repeated hospital admission is associated with a 373 g reduction of mean birthweight compared with healthy controls (2842 versus 2469 g; P < 0.05), although the mean gestation at birth in both groups was approximately 38 weeks. In the mild asthma group, such growth restriction was conspicuously absent. Furthermore, severe asthma was associated with a significantly higher incidence of low-birthweight infants compared with healthy controls and compared with births to women with mild asthma (P < 0.01). Although Murphy et al. found a moderate reduction of birthweight (93 g) in the infants of asthmatic mothers, no attempt was made to correlate this with the severity of the asthma or its acute exacerbations.1 The extent of maternal–perinatal hypoxia in asthma is likely to be related to the severity, frequency and duration of the hypoxic spells. Therefore, the general statement that ‘pregnant women with asthma are at significantly increased risk of a range of adverse perinatal outcomes…’ is probably an oversimplification of the problem.

The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis

Background: There is conflicting literature on the effect of maternal asthma on congenital malformations and neonatal outcomes. Objectives: This review and meta-analysis sought to determine if maternal asthma is associated with an increased risk of adverse neonatal outcomes. Search strategy: We searched electronic databases for: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Selection criteria: Cohort studies published between 1975 and March 2012 reporting at least one perinatal outcome of interest (congenital malformations, neonatal complications, perinatal mortality). Data collection and analysis: In all, 21 studies met inclusion criteria in pregnant women with and without asthma. Further analysis was conducted on 16 studies where asthmatic women were stratified by exacerbation history, corticosteroid use, bronchodilator use or asthma severity. Main results: Maternal asthma was associated with a significantly increased risk of congenital malformations (relative risk [RR] 1.11, 95% confidence interval [95% CI] 1.02–1.21, I2 = 59.5%), cleft lip with or without cleft palate (RR 1.30, 95% CI 1.01–1.68, I2 = 65.6%), neonatal death (RR 1.49, 95% CI 1.11–2.00, I2 = 0%), and neonatal hospitalisation (RR 1.50, 95% CI 1.03–2.20, I2 = 64.5%). There was no significant effect of asthma on major malformations (RR 1.31, 95% CI 0.57–3.02, I2 = 70.9%) or stillbirth (RR 1.06, 95% CI 0.9–1.25, I2 = 35%). Exacerbations and use of bronchodilators and inhaled corticosteroids were not associated with congenital malformation risk. Authors’ conclusions: Despite limitations related to the observational nature of the primary studies, this review demonstrates a small increased risk of neonatal complications among pregnant women with asthma. Further investigations into mechanisms and potential preventive interventions to improve infant outcomes are required