Perception of Wheezing in the Elderly Asthmatics

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the important features. The main reason for underdiagnosis is thought to be a low frequency in complaining of symptoms due to the reduction of intellectual recognition and physical activity. Among the various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreased complaints for wheezing are also noted in elderly asthmatics. The objective of this study is to determine if less complaints of wheezing in elderly asthmatic is due to a decrease in the development of wheezing. METHODS: 61 young (20-39 years old), 68 middle-aged (40-59 years old) and 65 elderly (older than 60 years old) stable asthmatic subjects were studied (each group shall be called, hereafter, Young Group, Middle-aged Group and Old Group, respectively). During the methacholine induced airway narrowing, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted in 194 asthmatics. RESULTS: One hundred and sixty-nine patients (87%) developed wheezing during the methacholine induced airway obstruction. The frequency of wheezing during the methacholine challenge was found to be comparable among the groups. The methacholine concentration, % fall in FEV1, and FEV1 levels of the initial detection of wheezing were not different among the groups. Among the patients who developed wheezing, 47 patients (77%), 42 patients (61.8 %) and 26 patients (40%) complained of wheezing in Young, Middle and Old Group, respectively. CONCLUSION: In conclusion, the decreased perception of wheezing is a main factor for the low frequency of complaints of wheezing in elderly asthmatics.

Clinical features of eosinophilic bronchitis / 대한내과학회지

BACKGROUND: Sputum examination is known to be a valid and reliable method in assessing airway inflammation. Eosinophilic inflammation of airway is usually associated with airway hyperresponsiveness and reversibility. But eosinophilic bronchitis present with chronic cough without the abnormality of airway function. The objectives of this study are 1) to investigate the incidence of eosinophilic bronchitis in the chronic cough syndrome and 2) to evaluate the clinical features of eosinophilic bronchitis. METHODS: We evaluated 92 patients who had been coughing for more than 3 weeks. In addition to usual diagnostic protocol, we performed sputum analysis for differential cell count. Eosinophilic bronchitis was diagnosed if patients had normal spirometric values, normal peak expiratory flow variability, no airway hyperresponsiveness, and sputum eosinophilia (>3%). RESULTS: The causes of chronic cough were post-nasal drip in 33%, cough variant asthma in 16%, bronchitis in 15%, and eosinphilic bronchitis in 12%. Initial eosinophil percentage in sputum of patients with eosinophilic bronchitis was 26.8+/-6.1% (3.8-63.7%). Treated with inhaled steroid, subjective improvement in cough and significant decrease in sputum eosinophil percentage (from 29.1 +/-8.3% to 7.4+/-3.3%) were observed. During the follow up period, increases in sputum eosinophil percentage with aggravation of symptom were found. CONCLUSION: Eosinophilic bronchitis is an important cause of chronic cough. Assessment of airway inflammation by sputum examination is important in investigating the cause of chronic cough. Symptoms in eosinophilic bronchitis are effectively controlled by inhaled corticosteroid, but they may follow chronic course.

Perception of wheezing in the elderly asthmatics / 대한내과학회지

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. METHODS: Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. RESULTS: One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. CONCLUSION: In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.

Clinical characteristics and inflammatory cells in sputum from asthmatics with acute exacerbation / 천식및알레르기

BACKGROUND: irway inflammation is considered to be important to the pathophysiology of asthma. Recently, several studies suggested that the frequency of acute severe asthma and death caused by acute exacerbation was increasing and that neutrophils were predominant in some sputum from severe or fatal asthmatic patients. OBJECTIVE: To examine clinical and physiological factors that determine the different cellular profiles in airway inflammation, we analyzed the individual characteristics of patients with acute asthma. METHODS: We performed cellular analysis on spontaneous or induced sputum from 27 subjects with acute asthma exacerbation (PEFR10%) (group 1) and neutrophil dominant (neutrophil 70%) (group 2). We compared the laboratory, clinical and physiological data. RESULTS: Twenty-two cases consisted of pure acute asthmatic patients without organic changes. Their sputum contained increased eosinophils, neutrophils, or both compared with the sputum from normal subjects. The cases of group 1 were more frequent (63.6%) than group 2 (36.4%) (p=0.001). The subjects included in group 1 were younger (mean 38.5 vs 58.6 years) (p<0.05) and had fewer smoking amounts (4.5 vs 10.8 pack years) (p=0.005) than group 2. The other factors were not different significantly. CONCLUSION: Old age and heavy smoking are important factors associated with neutrophil dominant airway inflammation in acute asthma. Further studies are needed to clarify the relationship between cellular composition, asthma severity and treatment response in asthma patients with neutrophil dominant sputum.