Clinical Interventions in Aging

Management of asthma in the elderly patient

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Authors: Melani AS

Published Date July 2013 Volume 2013:8 Pages 913 - 922

DOI: http://dx.doi.org/10.2147/CIA.S33609

Received:	10 April 2013
Accepted:	22 May 2013
Published:	15 July 2013

Andrea S Melani

Fisiopatologia e Riabilitazione Respiratoria, Dipartimento Vasi, Cuore e Torace, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy

Abstract: A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics.

Keywords: asthma, beta2-agonists, inhaled corticosteroids, asthma control, elderly



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Letter to the Editor

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Blue light irradiation suppresses dendritic cells activation in vitro

1. Michael R. Fischer^†, 
2. Manuela Abel^†,
3. Susanna Lopez Kostka, 
4. Berenice Rudolph,
5. Detlef Becker, 
6. Esther von Stebut^*

Article first published online: 23 JUL 2013

DOI: 10.1111/exd.12193

© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue

Experimental Dermatology

Volume 22, Issue 8, pages 558–560, August 2013

• Abstract
• Article
• References
• Supporting Information
• Cited By

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Keywords:

• atopic dermatitis;
• blue light;
• dendritic cells;
• immunosuppression

Abstract

Blue light is a UV-free irradiation suitable for treating chronic skin inflammation, for example, atopic dermatitis, psoriasis, and hand- and foot eczema. However, a better understanding of the mode of action is still missing. For this reason, we investigated whether dendritic cells (DC) are directly affected by blue light irradiation in vitro. Here, we report that irradiation neither induced apoptosis nor maturation of monocyte-derived and myeloid DC. However, subsequent DC maturation upon LPS/IFNγ stimulation was impaired in a dose-dependent manner as assessed by maturation markers and cytokine release. Moreover, the potential of this DC to induce cytokine secretion from allogeneic CD4 T cells was reduced. In conclusion, unlike UV irradiation, blue light irradiation at high and low doses only resulted in impaired DC maturation upon activation and a reduced subsequent stimulatory capacity in allogeneic MLRs with strongest effects at higher doses.

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Oral administration of poly-γ-glutamic acid prevents the development of atopic dermatitis in NC/Nga mice

1. Sung Won Lee^1,2,†, 
2. Hyun Jung Park^1,†,
3. Se-Ho Park^2,*, 
4. Seokmann Hong^1,*

Article first published online: 23 JUL 2013

DOI: 10.1111/exd.12198

© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue

Experimental Dermatology

Volume 22, Issue 8, pages 561–563, August 2013

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• Cited By

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Keywords:

• atopic dermatitis;
• cytokine;
• mast cell;
• poly-γ-glutamic acid;
• T helper differentiation

Abstract

Bacillus subtilis-derived poly-γ-glutamic acid (γPGA) has demonstrated adjuvant activity in promoting Th1/Th17 cell differentiation. Here, the NC/Nga (NC) mouse model was used to determine whether γPGA modulates the outcome of atopic dermatitis (AD), which is known to be a Th2-biased immune disease. We found that oral administration of γPGA dramatically reduced the development of AD in NC mice. Antigen-presenting cells activated with γPGA produced pro-inflammatory cytokines, such as IL12/23 and IFNγ, which, in turn, induced the differentiation of Th1 and Th17 cells. Concomitantly, Th2 responses, such as high levels of serum IgE, were dramatically decreased. Furthermore, in vivo γPGA treatment altered several cellular components of allergic reactions, such as mast cells and eosinophils. Taken together, our results strongly demonstrate that in vivo treatment with γPGA at early time points can prevent the development of AD in NC mice and suggest that γPGA may have therapeutic applications for human AD.

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Research

Elimination of Aspergillus fumigatus conidia from the airways of mice with allergic airway inflammation

Marina A Shevchenko, Elena L Bolkhovitina, Ekaterina A Servuli and Alexander M Sapozhnikov

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Respiratory Research 2013, 14:78 doi:10.1186/1465-9921-14-78

Published: 27 July 2013

Abstract (provisional)

Background

Aspergillus fumigatus conidia can exacerbate asthma symptoms. Phagocytosis of conidia is a principal component of the host antifungal defense. We investigated whether allergic airway inflammation (AAI) affects the ability of phagocytic cells in the airways to internalize the resting fungal spores.

Methods

Using BALB/c mice with experimentally induced AAI, we tested the ability of neutrophils, macrophages, and dendritic cells to internalize A. fumigatus conidia at various anatomical locations. We used light microscopy and differential cell and conidium counts to determine the ingestion potential of neutrophils and macrophages present in bronchoalveolar lavage (BAL). To identify phagocyte-conidia interactions in conducting airways, conidia labeled with tetramethylrhodamine-(5-(and-6))-isothiocyanate were administered to the oropharyngeal cavity of mice. Confocal microscopy was used to quantify the ingestion potential of Ly-6G+ neutrophils and MHC II+ antigen-presenting cells located in the intraepithelial and subepithelial areas of conducting airways.

Results

Allergen challenge induced transient neutrophil recruitment to the airways. Application of A. fumigatus conidia at the acute phase of AAI provoked recurrent neutrophil infiltration, and consequently increased the number and the ingestion potential of the airway neutrophils. In the absence of recurrent allergen or conidia provocation, both the ingestion potential and the number of BAL neutrophils decreased. As a result, conidia were primarily internalized by alveolar macrophages in both AAI and control mice at 24 hours post-inhalation. Transient influx of neutrophils to conducting airways shortly after conidial application was observed in mice with AAI. In addition, the ingestion potential of conducting airway neutrophils in mice with induced asthma exceeded that of control mice. Although the number of neutrophils subsequently decreased, the ingestion capacity remained elevated in AAI mice, even at 24 hours post-conidia application.

Conclusions

Aspiration of allergen to sensitized mice enhanced the ingestion potential of conducting airway neutrophils. Such activation primes neutrophils so that they are sufficient to control dissemination of non-germinating A. fumigatus conidia. At the same time, it can be a reason for the development of sensitivity to fungi and subsequent asthma exacerbation.

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Topical amitriptyline combined with topical ketamine for the management of recalcitrant localized pruritus: A retrospective pilot study

• Timothy J. Poterucha, BS
, 
• Sinead L. Murphy
, 
• Paola Sandroni, MD, PhD
, 
• Richard H. Rho, MD
, 
• Roger A. Warndahl, RPh
, 
• William T. Weiss, RPh
,
• Mark D.P. Davis, MD

• Full Text
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• References
• Copyright

Vol. 92, No. 1-2, 2013

Issue release date: Published online first (Issue-in-Progress)

Free Access

Review

The Clinical Use of Cetirizine in the Treatment of Allergic Rhinitis Zhang L.a · Cheng L.b · Hong J.c  aDepartment of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing,bDepartment of Otorhinolaryngology, First Affiliated Hospital, Nanjing Medical University, Nanjing, andcDepartment of Pediatrics, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China  Corresponding Author Abstract Background: Cetirizine is among the first second-generation H1 antihistamines (SGAHs) developed to provide selective H1 receptor inhibition without central nervous system depression. Objective: The aim of this review is to summarize the amount of data collected over 25 years of clinical use of cetirizine and compare this with data available for other SGAHs in the management of patients with allergic rhinitis (AR). Methods: A comprehensive literature search for publications relating to cetirizine was performed using the Pubmed database, and relevant papers published in English were selected for detailed review. Results: Compared with the majority of other SGAHs, cetirizine was generally shown to have a more favourable pharmacological profile, to be well tolerated, be at least equally or more efficacious in attenuating/inhibiting nasal and ocular symptoms and to improve the quality of life in AR patients. The majority of clinical trials investigating the effect of SGAHs in AR patients further indicated that cetirizine was often employed as the main comparator active drug. Conclusion: Based on the evidence that cetirizine is a commonly employed active comparator drug in AR, it is tempting to suggest that cetirizine may be a suitable benchmark in the development of novel pharmacotherapies for AR. Copyright © 2013 S. Karger AG, Basel

Pharmacology 2013;92:14-25
(DOI:10.1159/000351843)

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 Allergy and Asthma Proceedings, Volume 34, Number 4

 Recurrent perioperative anaphylaxis in a 54-year-old man

Authors: Franxman, Timothy J.; Greenhawt, Matthew J.; Baldwin, James L.

Source: Allergy and Asthma Proceedings, Volume 34, Number 4, July/August 2013 , pp. 383-386(4)

Publisher: OceanSide Publications, Inc Abstract:

Reports suggest that perioperative anaphylaxis in patients undergoing general anesthesia range from 1 in 5000 to 1 in 20,000 with mortality rates as high as 9%. Because of the variety of medications that are used for general anesthesia and the rapid succession in which they are administered, it is often difficult to determine the etiology of a severe allergic episode in this setting. Antibiotics and anesthetics are notorious for precipitating allergic reactions and are often implicated. Other perioperative exposures and patient risk factors must also be considered. In this article, we describe the case of a patient who exhibited recurrent anaphylaxis episodes while trying to undergo a vital cardiac surgery.

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Keywords: Anesthesia; drug allergy; hypersensitivity; indolent systemic mastocytosis; perioperative anaphylaxis; surgery

Document Type: Research article

DOI: http://dx.doi.org/10.2500/aap.2013.34.3667

Affiliations: 1: Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan, USA

Publication date: 2013-07-01

Stratifying a Risk for an Increased Variation of Airway Caliber among the Clinically Stable Asthma

ORIGINAL ARTICLE Stratifying a Risk for an Increased Variation of Airway Caliber among the Clinically Stable Asthma doi:10.2332/allergolint.13-OA-0543 Atsushi Hayata, Kazuto Matsunaga, Tsunahiko Hirano, Keiichiro Akamatsu, Tomohiro Ichikawa, Yoshiaki Minakata and Masakazu Ichinose [About this authors] ABSTRACT Background: Recently, correlations of peak expiratory flow (PEF) variation have been shown to facilitate the prediction of later asthma symptoms and exacerbations. However, it has not been fully examined whether or not any patient characteristics are associated with the residual airway lability in treated asthmatics. The objective of this study is to examine a predictive marker for increased variation of PEF in patients with clinically stable asthma. Methods: We studied 297 asthmatic patients who were monitored for PEF twice a day. Asthma Control Questionnaire (ACQ), spirometry, and exhaled nitric oxide fraction (FENO) were measured. After the assessment of baseline values, PEF measuring was continued and associations between these clinical markers and later variation of PEF over a week (Min%Max) were investigated. Results: 17.5% of the subjects showed increased PEF variability (Min%Max < 80%). ACQ, forced expiratory volume in 1 s % of predicted (%FEV1), and FENO were identified as independent predictors of Min%Max < 80%. An ACQ ≥ 0.4 yielded 96% sensitivity and 59% specificity, a %FEV1 ≤ 85% yielded 62% sensitivity and 89% specificity, and a FENO ≥ 40 ppb yielded 75% sensitivity and 90% specificity for identifying the subjects with high variability in PEF. When we combine %FEV1 ≤ 85% and FENO ≥ 40 ppb, this index showed the highest specificity (98%) for increased PEF variability. Conclusions: These results indicate that ACQ, %FEV1 and FENO can stratify the risk for increased variation in airway caliber among patients with stable asthma. This may help identify subjects in whom further monitoring of lung function fluctuations is indicated. KEY WORDS: airflow limitation, airway hyperresponsiveness, airway inflammation, airway lability, peak expiratory flow rate ABBREVIATIONS: ACQ, Asthma Control Questionnaire; AHR, Airway hyperresponsiveness; FENO, Exhaled nitric oxide fraction; ICS, Inhaled corticosteroids; Min%Max, The lowest PEF over a week, expressed as a percentage of the highest PEF; PEF, Peak expiratory flow. Received: 28 January 2013. Accepted: 12 March 2013. Allergology International : In Press [Full Text PDF (179k)]