[Bronchodilator response in elderly patients]

Asthma in the elderly is more severe and a decreased bronchodilating response has been suggested as a contributing factor. There is no agreement on the best way of expressing reversibility. The aim of this study was to evaluate bronchodilator response in elderly patients with asthma with different levels of airway obstruction and expressing reversibility by different indices. A total of 72 asthmatic patients were studied: (FEV1/FVC < 1.64 SEE below predicted). Two groups were considered: Group I: > or = 65 years (71.0 +/- 11.7 years; FEV1 54.0 +/- 16.7% of predicted) and Group II: < 40 years (23.0 +/- 7.7 years, FEV1 67.6 +/- 16.1%). Response to bronchodilators expressed as delta absolute, delta%predicted or delta%maximal was not different between the two groups. Reversibility expressed as delta%initial, however, was lower in younger patients (> 65 years: 22.2 +/- 16.6% vs 40 years: 11.8 +/- 9.9%, p = < 0.005). A covariance analysis was performed using baseline FEV1 as covariate and bronchodilator response was not different between the two groups. Neither delta absolute (r = 0.13, p = NS), delta%predicted (r = 0.06, p = NS) nor delta maximal (r = 0.09, p = NS) showed correlation with age. delta%initial showed weak but significant correlation with age (r = 0.28, p = < 0.05) and marked dependence on baseline FEV1 (r = 0.47, p = < 0.001). Bronchodilator reversibility in the elderly asthmatics is preserved. Expressing reversibility as delta%initial produces differences depending on baseline airway obstruction.