Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149514 (bronchitis)
 6,902 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Asthma in the elderly is often underrecognized and suboptimally treated, resulting in an increased morbidity and mortality. The characteristics of asthma-related bronchitis and its optimal treatment remain to be determined in this population. We aimed to compare lung function and airway inflammation in elderly and younger asthmatic subjects. Data from two induced sputum databases were analyzed in three groups of asthmatic subjects (18-30 y, n = 136; 31-59 y, n = 385; 60-72 y, n = 172) and one group of healthy elderly subjects (60-89 y, n = 16). Expiratory flows and induced sputum cell counts were analyzed. Airway obstruction was more marked in elderly asthmatics compared with healthy elderly or younger asthmatic subjects (p < 0.01). An increase in sputum neutrophils and a decrease in macrophages and lymphocytes were observed in elderly asthmatics (p < 0.0001). Neutrophil percentages significantly increased with asthma severity in the young and the middle-aged groups, while they remained similar in elderly asthmatics regardless of asthma severity (p < 0.05). Neutrophil percentages weakly correlated with the dose of ICS in all asthmatics (r = 0.17, p < 0.0001). Age and dose of ICS were independent predictors of neutrophil percentage in asthmatic subjects in a regression model (R(2) = 0.12). Asthma in the elderly is associated with a more marked airway obstruction and sputum neutrophilia. Both age and the dose of corticosteroids need to be considered in the interpretation of the clinical relevance of sputum neutrophil count.
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PMID:Expiratory flows and airway inflammation in elderly asthmatic patients. 2154 32

The measurement of FeNO (fractional nitric oxide concentration in exhaled breath) is a noninvasive method to assess airway inflammation. The elevated level of FeNO in asthma patients was first reported in 1993, and measurement has been covered by insurance in Japan since April 2013. NO is generated through the conversion of L-arginine to L-citrulline by the action of nitric oxide synthase (NOS) and iNOS is highly expressed in asthmatic airways. FeNO is expiratory flow-ependent, and measurement at 50 mL/s is recommended. As a nitrate-rich diet and the contamination of nasal NO increase, and smoking and spirometry decrease FeNO, these factors should be avoided or taken into account when measuring FeNO. For clinical application, FeNO may be used for the diagnosis or as a guide to treat asthma. Although FeNO correlates well with eosinophilic airway inflammation, it is not present in all asthma patients, and eosinophilic bronchitis or a part of COPD also shows eosinophilic inflammation. Thus, FeNO may be used as an adjunct for asthma diagnosis, and in ATS guideline, it is recommended to use FeNO for the diagnosis of eosinophilic airway inflammation and determining the likelihood of responsiveness to steroids. Several studies attempted to use FeNO to determine the dose of ICS (inhaled corticosteroids) and compared FeNO with traditional guideline-based management. The results were inconsistent, and the Cochrane review found that FeNO-based treatment did not lead to a reduction in the ICS dose or improved asthma outcomes. Nevertheless, a study of a pregnant woman showed reduced exacerbations with a refined algorithm, and further research will shed light on the appropriate application of FeNO measurement for asthma management. In this paper, the mechanism of NO generation, background and method of FeNO measurement, and clinical application will be reviewed and an outline of the official ATS clinical practice guideline will be introduced.
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PMID:[The role of fractional nitric oxide in exhaled breath (FeNO) in clinical practice of asthma]. 2582 39