Asthma in the elderly: what we know and what we have yet to know

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients

Is Health-Related Quality of Life Associated with Upper and Lower Airway Inflammation in Asthmatics?

Background. Allergic diseases impair health-related quality of life (HR-QoL). However, the relationship between airway inflammation and HR-QoL in patients with asthma and rhinitis has not been fully investigated. We explored whether the inflammation of upper and lower airways is associated with HR-QoL. Methods. Twenty-two mild allergic asthmatics with concomitant rhinitis (10 males, 38 ± 17 years) were recruited. The Rhinasthma was used to identify HR-QoL, and the Asthma Control Test (ACT) was used to assess asthma control. Subjects underwent lung function and exhaled nitric oxide (eNO) test, collection of exhaled breath condensate (EBC), and nasal wash. Results. The Rhinasthma Global Summary score (GS) was 25 ± 11. No relationships were found between GS and markers of nasal allergic inflammation (% eosinophils: , ; ECP: , ) or bronchial inflammation (pH of the EBC: , ; bronchial NO: , ; alveolar NO: , ). The mean ACT score was 18. When subjects were divided into controlled (ACT ≥ 20) and uncontrolled (ACT < 20), the alveolar NO significantly correlated with GS in uncontrolled asthmatics (, ). Conclusions. Upper and lower airways inflammation appears unrelated to HR-QoL associated with respiratory symptoms. These preliminary findings suggest that, in uncontrolled asthma, peripheral airway inflammation could be responsible for impaired HR-QoL

The effect of intranasal corticosteroids on asthma control and quality of life in allergic rhinitis with mild asthma

Background. The mechanisms through which rhinitis affects asthma have not been completely elucidated. We explored whether the effect of nasal treatment on asthma control and respiratory-related quality of life (HRQoL) is mediated by inflammatory changes of the upper and lower airways. Methods. Allergic rhinitics with mild asthma were randomized to a 14-day treatment period with either nasal budesonide 100 \uce\ubcg, 1 puff per nostril twice a day, or placebo. Clinical, functional, and biological evaluations were performed before and after treatment. Results. Twenty subjects (M/F: 10/10; age: 31 \uc2\ub1 15 years; mean \uc2\ub1 SD) were enrolled, and a total of 17 individuals completely participated in the study. Lung function was within the normal range. The total asthma control test (ACT) score was 20 \uc2\ub1 5.3 and the RHINASTHMA Global Summary (GS) was 44 \uc2\ub1 15. The percentage proportion of eosinophils in nasal lavage was 9.9% and significantly correlated with spirometric parameters reflecting peripheral airway function (for FEF50: r = 0.48, p = .03; for FEF25: r = 0.47, p = .03). The pH of the exhaled breath condensate (EBC) was 7.33 \uc2\ub1 0.4. After nasal treatment, the percentage proportion of eosinophils fell significantly (p = .002), and changes in percentage proportion of eosinophils were associated with changes both in the ACT score (r = 0.76, p = .04) and in the RHINASTHMA GS (r = 0.77, p = .02). The increase in the pH of the EBC was not associated with changes in the ACT score or with the RHINASTHMA GS. Conclusions. These findings confirm that, in subjects with allergic rhinitis with mild asthma, nasal inflammation impacts on asthma control and HRQoL. The improved control of respiratory symptoms obtained with nasal corticosteroids seems to be mediated by functional changes in the peripheral airways. \uc2\ua9 2011 Informa Healthcare USA, Inc

Interventi di retrofit, IEQ e risparmio energetico

Traditional energy retrofit interventions focus on reducing energy requirements and costs, which can be achieved by acting on the envelope or on the plants, without taking into account that the conditions of indoor air quality and thermal, visual and acoustic comfort, provided for by current legislation, must be maintained. To the in place mea-surement campaigns of the energy parameters before and after the retrofit intervention, should be added those relating to the IEQ sectors. The results of the various measures in the field must be analyzed in synergy, using a rigo-rous or simplified approach, evaluating the sensitivity of energy costs to individual retrofit interventions, always on equal terms. This theme is addressed in all fields by the Operative Units 2 and 4. This paper presents an example case study that simply gives an idea of the problem