Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 54, Issue 3 M136-M139, Copyright © 1999 by The Gerontological Society of America
Do respiratory symptoms predict chronic airflow obstruction and bronchial hyperresponsiveness in older adults?
DS Renwick and MJ Connolly
University Department of Medicine for the Elderly, Barnes Hospital, Manchester, UK.
BACKGROUND: Respiratory symptoms are common in older adults. In young
populations the predictive value of such symptoms for chronic airflow
obstruction and bronchial hyperresponsiveness is low. We investigated
whether symptoms predict airflow obstruction and bronchial responsiveness
in adults aged 45-86 years. METHODS: An age-stratified random sample of
white adults aged 45 years and older was obtained from family doctor lists
in Central Manchester, UK, and sent a respiratory symptoms questionnaire
(exclusions: housebound, confused). Responders were invited to participate
in a methacholine challenge (Newcastle dosimeter method; exclusions:
ischemic heart disease, oral steroids, anticholinergic or beta-blocker
medication). RESULTS: Of 783 eligible subjects, 723 responded (response
rate 92.3%). Symptoms were reported by 53.8%. Methacholine challenge was
completed by 208 subjects. Sixty- five (26.4%) had chronic airflow
obstruction, of whom 76.6% reported respiratory symptoms. Bronchial
hyperresponsiveness (PD20 < or = 100 micrograms) was present in 26.0% of
subjects overall, and in 36.8% of symptomatic and 14.6% of asymptomatic
subjects (p < .001). Of those with bronchial hyperresponsiveness, 26.4%
were asymptomatic. Predictive values of symptoms for chronic airflow
obstruction and bronchial hyperresponsiveness were low. CONCLUSIONS:
Respiratory symptoms, chronic airflow obstruction, and bronchial
hyperresponsiveness were all common in this adult population sample.
However, the predictive value of symptoms for airflow obstruction/bronchial
hyperresponsiveness was low. It was concluded that respiratory symptoms do
not identify adults with airflow obstruction or bronchial
hyperresponsiveness. Investigation by spirometry and peak flow monitoring
is necessary to guide appropriate management.
