Bronchial asthma in the elderly. Relationship to allergic reaction and airway inflammation

Clinical features of bronchial asthma in the elderly were analyzed by observlng IgE-mediated allerglc reactions evaluated by immediate skin reaction and specific IgE antibodies to allergens, ventilatory function and cellular composition in bronchoalveolar lavage (BAL) fluid. 1. The frequency of positive immediate skin reaction and positive RAST score to allergens was in general low in the elderly patients over age 70. 2. Ventilatory function was widely variegated, and fifteen cases (60%) of the 25 Subjects showed considerably high values of FEV(l.0%), % PEFR, % MMF, % V(50) and % V(25), and the mean value of FEV(1.0%) in these cases was 71.3%. 3. The decreased value of % V(25) was related to BAL neutrophilia in 2 cases, but any correlation was not found between BAL neutrophilia and decreased value of % V(25) in 9 csese of the eleven subjects who had the BAL examination. The results show that in asthma of elderly patients, IgE-mediated allergic reactions are weak, and that a decreased value of % V(25) can be observed without BAL neutrophilia.

70才以上の老年者気管支喘息の特徴について,アレルゲンに対する即時型皮膚反応および特異的IgE抗体,換気機能,気管支肺胞洗浄液(BAL)中の細胞成分などにより検討した｡1.アレルゲンに対する即時型皮膚反応および特異的IgE抗体の陽性率は,全般的にかなり低い傾向を示した｡2.換気機能にはかなりのばらつきが見られたが,25例中15例(60%)では,,いずれの換気パラメー ターもかなり高い値を示し,これらの症例の平均FEV(1.0%)は71.3%であった｡3.BALを施行した11例中,% V(25)値の低下とBAL中好中球増多との間に関連の見られた症例は2例のみで,他の9例では% Ⅴ(25)値の高度な低下にもかかわらず,BAL中の好中球増多は見られなかった｡これらの結果より,老年者気管支喘息では,IgEにmediateされるアレルギー反応は全般的に弱いこと,またBAL液中好中球増多なしに% V(25)値の高度な低下が出現してくることが示された｡