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The Characterization of Bronchoalveolar Lavage Fluid in Very Elderly Patients With Cerebrovascular Disease

^a Department of Geriatric Medicine, Tokyo Medical University, Japan
^b Department of Internal Medicine, YuYu-kenkoumura Hospital, Nagaoka, Japan

Masayuki Kikawada, Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan E-mail: kikawada{at}tokyo-med.ac.jp.

Decision Editor: John E. Morley, MB, BCh

Background. Elderly patients with cerebrovascular disease have a high frequency of pneumonia due to impaired immune function and the occurrence of micro-aspiration.

Methods. We performed bronchoalveolar lavage in 11 very elderly subjects with cerebrovascular disease and 9 healthy volunteers to investigate whether there were changes of local immunity in the lungs of the elderly subjects. The total cell count, the cell characteristics, and the lymphocyte subsets in bronchoalveolar lavage fluid were compared between the two groups.

Results. A significant increase in the total cell count as well as in the number of neutrophils and CD8⁺ T cells was observed in the elderly group. In addition, the mean CD4/CD8 lymphocyte ratio was lower in the elderly patients than in the healthy volunteers.

Conclusions. These observations suggest that silent micro-aspiration occurs in many elderly individuals with cerebrovascular disease and that pulmonary defenses decrease with age.