Multifaceted interventions to reduce acute exacerbations in elderly asthmatics

BACKGROUND: Although many risk factors are known to be associated with poor asthma outcomes in the elderly, the literature on the effect of risk factor control on asthma outcomes in the elderly is very sparse. OBJECTIVE: To evaluate the role of multifaceted interventions in reducing acute exacerbations in elderly asthmatics. METHODS: A total of 100 subjects were randomly selected from our prospective cohort of elderly asthmatics aged 65 years or older and were provided multifaceted intervention for 1 year. Our multifaceted interventions included repeated education on asthma and inhaler technique for patients and their caregivers, provision of an action plan to cope with acute exacerbations, short message service to prevent follow-up losses, and oral replacement of magnesium. The primary outcome was an acute asthma exacerbation rate compared to the previous year. RESULTS: Ninety-two subjects completed this study, although only 58 subjects continued to take magnesium. Compared to the previous year, the acute asthma exacerbation rate showed a significant reduction from 67% to 50% (p = 0001) and significant improvement was observed in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) (p = 0.04, p = 0.036 for each). Interestingly, a subgroup analysis revealed that predicted value of FEV1 increased significantly in subjects who continued to take magnesium from 79.6% to 87.1% (p = 0.008). CONCLUSION: To reduce acute exacerbations in elderly asthmatics, a multifaceted approach in increase medical awareness, proficiency and adherence to inhaler, assistance of caregivers and correction of micronutrients deficiency is likely to be effective. In addition, a continuous oral replacement of magnesium may increase FEV1 in elderly asthmatics.

Immune status in patients with chronic obstructive pulmonary disease during acute exacerbations and medication intervention / 中国实用内科杂志

Objective To investigate immune changes in patients with chronic obstructive pulmonary disease during exacerbations(ECOPD).Methods A randomized,prospective clinical trial was done in 65 patients with ECOPD from Feb.2004 to Oct.2004.They were divided into two groups:one group with general treatment and another with general treatment plus Pidotimod which was given 800mg orally twice daily for 15 days and then 800mg orally once daily for 15 days.Twenty healthy individuals sevred as the control.Levels of CD_ 14 、CD_ 158b 、CD~+_3、CD~+_4、CD~+_8、CD~+_4/CD~+_8 in peripheral blood were measured by flow cytometry at baseline(D1)and then again at(D15)and at the end of treatments(D30),in the meanwhile clinical picture was observed to evaluate patients' conditions.Results Totally 60 patients completed the trial correctly(30 in pidotimod group and 30 in control group).The two groups were satistically homogeneous.The positive rate of sputum bacteriological examination was 42.67%.On D1,the percentage of CD_ 14 、CD_ 158b in two groups was not different from healthy volunteers.On D15,the above immunologic parameters of the control group was decreased compared with pidotimod group,and CD_ 14 was satistically low(P