Characteristics of ventilatory function in clinical types of bronchial asthma in the elderly

Ventilatory function was examined in 55 patients with asthma (25 older patients over the age of 60 and 30 younger patients under the age of 59) in relation to four clinical types classified by clinical symptoms and signs. 1. Regarding cellular composition of bronchoalveolar lavage (BAL) fluid, number of BAL neutrophils was significantly increased in type II, bronchiolar obstruction type, of older and younger patients compared to that in type la-1 and type la-2 of same patients. In contrast, BAL eosinophilia was observed in type la-2 of both older and younger patients and in type Ib of younger patients. 2. The values of % FVC, FEV(1.0%) and % PEFR were not significantly different among four clinical types of asthma and between older and younger patients, although the values of these ventilatory parameters in type II asthma showed a tendency to be lower compared to other clinical types. 3. The values of % MMF, % V(50), and % V(25), showing ventilatory dysfunction of small airways, were lowest in type II asthma of both older and younger patients among four clinical types. A significant difference in these ventilatory parameters of type II asthma compared to type la-1 asthma was observed in younger patients, but not in older patients. These results show that ventilatory dysfunction of small airways is related to clinical asthma types in younger patients, and to aging rather than asthma types in older patients.

気管支喘息55例(老年症例-65才以上-25例,若年症例-59才以下-30例)における換気機能の特徴について,各臨床病型別に検討を加えた｡1.まず対象症例の臨床病型の病態的特徴を,気管支肺胞洗浄(BAL)液中の細胞成分で検討 すると,Ⅱの細気管支閉塞型の症例では,好中球の増加が,またIa-2やIbの過分泌型の症例では好酸球の増加が特徴的であった｡2.% FVC,FEVL(1.0%),% PEFRなどの換気パラメーターは,Ⅱ型において他の病型に比べ低値を示す傾向は見られたが,各病型間に有意差は見られなかった｡3.% MMF,% V(50),% V(25)などのどちらかと言えば小ないし細気管支領域の換気障害を示す換気パラメーターの値は,老年および若年症例ともⅡ型(細気管支閉塞型)において最も低い値が示された｡そして,若年症例では,Ⅱ型の症例においてこれからの換気パラメーターの値は,Ia-1型(単純性気管支攣縮型)に比べ有意に低い値を示した｡しかし,老年症例ではⅡ型におけるこれらの換気パラメータ-の値は,他の臨床病型との問に有意の差は見られなかった｡