A review of the diagnosis and treatment of asthma in older adults was just published in The American Journal of Medicine. Asthma in older adults can fall into two broad groups: those with long-standing disease, present since childhood; and those with late-onset asthma. The review was aimed at this latter group.
With late-onset asthma there is greater likelihood for confusing asthma with other conditions, especially COPD (chronic obstructive pulmonary disease) and congestive heart failure. In pulmonary testing, patients with both COPD and asthma will show obstruction of air flow, but this obstruction improves with inhalation of a bronchodilator in asthmatics, but not in COPD patients.
Another distinguishing fact in pulmonary testing is how the diffusion capacity of gas from lung to blood- stream is normal in asthma, but is decreased in COPD.
In comparing lifelong asthmatics with late-onset, the former more commonly have other allergic symptoms, such as hay fever or food allergy. The former respond very quickly to a bronchodilator, while the older asthmatic may need up to 30 minutes to feel the benefit of a bronchodilator.
Also, older asthmatics often will respond better to a combination bronchodilator with both albuterol and ipatropium, rather than albuterol alone. The inflammatory cells that cause airway inflammation are different. In young asthmatics it’s neutrophils. This fact alone, coupled with the burgeoning baby-boomer population has led to intense research to find anti-inflammatories that work better on neutrophil cells.
Older asthmatics seem more prone to respiratory infections which exacerbate the asthma. In part, this susceptibility is from aging of the immune system.
But another recently discovered cause is that older asthmatics tend to not keep their inhalers and spacers clean, allowing them to become colonized with disease-causing bacteria.
Benign paroxysmal positional vertigo (BPPV) is by far the most common type of dizziness, affecting 3 -to-4 percent of the population at some point. Some people have a single, brief attack, whereas others can have repeated and sometimes prolonged episodes.
The condition is more common in people over 50, in women more than in men (3:1), in persons with osteopenia or osteoporosis and those low in vitamin D. Dizziness typically occurs while rolling over in bed, getting in or out or tilting the head back or for- ward. Many patients also have nausea.
BPPV is caused by little dislodged crystals getting into one of the ear’s three semi-circular canals that stimulate nerve endings, leading to a vertiginous nerve signal being sent to the brain. Therapy involves special head maneuvers to reposition the out- of-place crystals. An accurate diagnosis and instruction in proper therapeutic maneuvers are best done at a balance center.
Good news for the roughly 50 percent of psoriasis sufferers whose current treatment fails to control their chronic itching — a novel therapy has been re- ported by researchers at Temple University. Instead of indirectly combatting the itching through steroid creams that reduce skin inflammation, their drug goes right to the specific cause of the itch. The new cream, only called CT327, inhibits TrkA kinase, a compound responsible for pruritis (itching).
In the Temple research study there was a 60 per- cent reduction in itching. The therapy was safe with few side effects.
Dear Dr. K.: In cold months I get episodes when my hands get red, swell, itch and burn for days at a time. The problem was even worse when I visited my daughter in Toronto. Could I be allergic to cold?
The answer to your question is yes, but I don’t think that is the actual cause of your problem.
In the past 20 years there has been an extensive amount of research on a group of conditions called “physical allergy.” One common physical allergy is cold urticaria (hives). But your problem sounds more like a condition called pernio. Unlike cold urticaria which comes and goes quickly, pernio symptoms last for days at a time.
Pernio typically affects the acral parts of the body: hands, feet and nose. These are the areas of the body that tend to be coolest owing to exposure and being at the end of the blood circuit. In most cases pernio is a benign condition with no known cause. But in a few individuals it can be a harbinger of some other disease process. It is known to be more common in smokers, which makes sense because it is known that cigarette smoking narrows blood vessels. Most people with pernio have normal labs, but some show cold-activated proteins such as cold agglutinins or cryoglobulins. These can occur due to an underlying infection such as strep or hepatitis. Other lab results can be abnormal if the cause for the pernio is an autoimmune condition such as vasculitis, lupus, or rheumatoid arthritis.
The onset of pernio can also occasionally be the first sign of a cancer, such as multiple myeloma, breast or colon cancer. Because there is a possibility of underlying disease, it is a good idea to see your primary care doctor and have a good physical.
If no cause is found, pernio is treated by first keeping warm. Smoking cessation is very important. Typical treatments can help, such as cortisone creams and nitroglycerin ointment (it dilates blood vessels). If the symptoms are severe, oral therapies that help blood flow improve include aspirin, minoxidil, nicotinamide and pentoxifylline.
Avoiding carbs known as FODMAPS (trust me, you don’t have to know the acronym’s long name), may help prevent irritable bowel syndrome. Vocabulary words to remember for these short-chain carbohydrates include fructose, lactose, fructans (found in wheat), galactans and polyol sweeteners. Remembering this list is important in fending off this painful syndrome because the body has a hard time absorbing these items. They remain in the GI tract and become a source of “GI tumult” when the gut bacteria ferment them. Galactans are found in dried beans and peas, and while polyol sweeteners are in lots of healthy fruits with pits or stones (e.g., peaches), they are also are used in many artificial sweeteners