How common is increased airway reactivity amongst the elderly?

A random sample of subjects over 65 years of age who had replied to a postal questionnaire on respiratory symptoms was asked to attend for lung function studies and, if fit, an inhaled methacholine bronchial challenge. Of 283 subjects, 180 (63.6%) agreed to attend. Most (98%) subjects performed reproducible spirometry, with no evidence of fatigue on repeated testing. However, 20 subjects were found to be unsuitable for challenge (forced expiratory volume in 1 s, (FEV1) < 1 litre or unable to perform spirometry reproducibly). The dose of methacholine producing a 20% fall in FEV1 was termed the PD20. A positive challenge with PD20 < 6.13 mumol methacholine was found in 69 of 160 (43%) subjects studied, with highly reactive airways (PD20 < 1.0 mumol methacholine) in 19 of 160 (12%). Bronchial hyperreactivity, which is closely associated with clinical asthma, was found to be far more common amongst the elderly than previously recognised. Low initial FEV1 (1-1.5 litres) predisposed to both a positive challenge (p < 0.01) and also to highly reactive airways (p < 0.01), generally associated with respiratory symptoms. Subjects with low (1-1.5 litres) baseline FEV1 were five times more likely to have highly reactive airways than those with FEV1 > 1.5 litres, confirming a relationship between baseline airway calibre and bronchial reactivity. Early detection of subjects with low FEV1, who are therefore more likely to have increased airway reactivity, may help to reduce respiratory morbidity in the elderly with considerable benefit both to patients and to the Health Service.

Respiratory symptoms among elderly people in the New Forest area as assessed by postal questionnaire.

This study was carried out to estimate the prevalence of respiratory symptoms among people aged 65 years and older and assess the value of a postal survey in obtaining this information. A questionnaire was sent to 2011 subjects (957 men) drawn by age-stratified random sampling from the age-sex registers of four New Forest group practices (1:3.3 sample). A total of 1803 replied, a 96.2% response after excluding 136 who had died or moved from the area. The accuracy of replies was verified for 355 (20%) randomly selected subjects. Forty per cent had no respiratory symptoms. Exertional breathlessness was common (38%), increasing in prevalence with age but not with smoking history, and was the only symptom reported by 10% of subjects. Only 14.2% were current smokers; more of the subjects aged 85 years and over were lifelong non-smokers. Two hundred and ninety-six (16.4%) had chronic bronchitis, which was more common among smokers; 151 (8.4%) gave a history of asthma, of whom half (76) had active asthma, which was slightly less common among the very elderly subjects. Only 489 (27.1%) of subjects had seen their doctors with chest symptoms during the preceding 2 years.

The effect of methacholine inhalation challenge on regional residual volume in patients with subclinical asthma.

Regional residual volume to total lung capacity (RVr/TLCr) was measured with xenon 133 before and after methacholine challenge in 26 nonsmoking subjects (mean age 34 years). Eleven were normal control subjects and 15 were patients referred for methacholine challenge because of previous asthma-like symptoms. All had normal pulmonary function and normal RVr/TLCr distribution. Following methacholine challenge, RVr/TLCr increased in two control subjects and ten patients who also had decreases in FEV1 of greater than 20 percent. The RVr/TLCr changes were patchy, suggesting that the degree of bronchospasm varied between individual lung regions. The other 14 subjects did not have a 20 percent decrease in FEV1, but two controls and four patients had generalized increases in RVr/TLCr, while seven controls and one patient had no significant changes in RVr/TLCr. In all subjects, FEV1 and RVr/TLCr returned to the baseline level after salbutamol administration. The results indicate that methacholine can cause localized or diffuse effects on lung emptying and that bronchodilator completely reverses the bronchoconstriction induced by methacholine.

Bronchial submucosal needle aspiration performed through the fiberoptic bronchoscope.

Retrospective review of 251 bronchial submucosal needle aspirations obtained from 171 patients with unsuspected pulmonary malignancy showed that adequate cytologic material was obtained in 87.6% of the aspirations. Eighty-one patients were found to have primary bronchogenic carcinomas (with a visible endobronchial tumor in 39), and 21 had secondary pulmonary metastases. The overall diagnostic accuracy of bronchial submucosal aspiration was 81%, with only four definite false-negative and no false-positive results. The diagnostic accuracy was 82% for bronchial brushing, 71% for forceps biopsy, 67% for postbronchoscopy sputum cytology and 46% for bronchial washing. The major advantage of the submucosal aspiration technique was in evaluating mural mucosal lesions, especially those covered with intact mucosa, that were not readily accessible to forceps biopsy or successful brush sampling. Negative results from a needle aspiration must be interpreted with caution because of the small area a single sample represents. Multiple sequential submucosal aspirations may be helpful in assessing the resectability of bronchial neoplasms. No complications have been encountered with this technique.