高齢者気管支喘息の病態におよぼす加齢および喫煙の影響について(2)

高齢者気管支喘息について.IgEにmediateされるアレルギー反応の特徴、臨床病態,肺機能(換気機能,ガス交換),気腫化傾向,治療上の問題点などを検討した. 1.高齢者喘息におけるIgE抗体の関与は予想外に多く,しかもアレルギーの家族歴を有する症例で特に高度であった。また,加齢とともに感作される抗原の種類が異なってくることが示唆された。 2.臨床病態では,単純性気管支攣縮型に比べ,気管支攣縮+過分泌型や細気管支閉塞型が増加する傾向が見られた｡ 3.肺機能では,airflow (% FVC,FEV1.0%)ゃlung volume(% RV)をあらわすパラメーターは,いずれも70才以上の症例で若青年者喘息に比べ有意に低下していることが示された｡また,transfer factor(% DLco)も70才以上の症例では有意の低下傾向が見られた。 4.HRCT上の1950HU以下の肺の% UIAは,加齢とともに増加する傾向を示し,% RVの増加と同様肺の気腫化傾向が見られること,しかし,この現象が肺気腫へと移行することはないことが示された. 5.治療上では,薬物療法よりも気道の浄化を促す吸入や水中運動(温泉療法など)が重要であると考えられた｡

Influences of aging and cigarette smoking on the pathophysiology in elderly patients with asthma was examined in relation to characteristics of IgE-mediated allergic reaction, clinical pathophysiology, pulmonary function (ventilatory function and gas exchange ability; DLco), emphysematous change of the lungs, and therapy for the disease. 1. Participation of IgE-antibodies in the onset mechanisms of elderly asthma was more predominant in patients with a family history of allergic desease than those without the family history. 2. Regarding asthma classified by clinical findings, the number of patients with hypersecretion or bronchiolar obstruction was larger than the number of those with simple bronchoconstriction type. 3. The values of parameters showing airflow (% FVC, FEV 1.0%) and lung volume (% RV), as well as the value of DLco, were significantly lower in elderly asthmatics compared to younger patients. 4. The low attenuation area (LAA) of the lungs <-950 HU on HRCT, showing emphysematous changes, as well as % RV, showed a tendency to increase as patient age become higher, however, these changes never shifted to emphysema. 5. In the treatment of elderly asthma, clear-up of the airways by inhalation and / or swimming training in a hot spring pool, but not by medication, is very important.

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