Respiratory symptoms and airways disease in the elderly

An epidemiological investigation of respiratory symptoms and airways disease was performed in elderly people at 3 general practices in and around Southampton. Almost 60% of a random sample of 2161 subjects aged 65 years and over complained of one or more respiratory symptoms. The most frequent complaints elicited from a postal questionnaire were wheeze (28.4%), morning phlegm (21.6%) and daytime breathlessness at rest (20.6%). Smoking showed a stronger association with respiratory symptoms than age, sex or social class. Nearly one third of the sample had seen their doctor in the preceding 12 months for a perceived chest illness. Examination of the interrelationship of respiratory symptoms showed that symptoms of the `bronchial irritability syndrome' namely nocturnal breathlessness, chest tightness on waking of greater or equal to one hour and breathlessness or wheeze in response to respiratory irritants were not closely grouped together. Further investigation of selected groups of subjects with or without symptoms demonstrated a high prevalence of airways obstruction and airways lability (bronchial hyper-responsiveness or bronchodilator reversibility). Tobacco smoking showed a strong relationship with airways obstruction. An FEV1/FVC less than or equal to 60% was recorded in 31% of current smokers, 18% of ex-smokers and 5% of non-smokers. Generally respiratory symptoms were poorly predictive of airways lability. Symptoms of the bronchial irritability syndrome were more strongly associated with airways lability than most other symptoms but their predictive value for airways lability (32%) was lower than has been reported in younger adults. The relationship between tobacco smoking, allergy and respiratory function was also examined. Raised serum IgE (≥81 IU/ml) was strongly associated with airways obstruction in non-smokers and smokers. Both raised serum IgE and smoking interacted in a multiplicative manner suggesting that smoking related airways obstruction may have an immunological basis.