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Influence of cigarette smoking on the pathogenesis of asthma in the elderly remains controversial. This study was undertaken to clarify the influence of cigarette smoking on IgE-mediated allergy, bronchial hyperresponsiveness, and the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leukocytes in 48 elderly patients (25 patients with a history of smoking for more than 20 years and 23 never-smokers) with asthma over the age of 70 years. 1. The incidence of positive IgE antibodies for inhalant allergens was significantly higher in asthmatics with a history of smoking than in never-smokers of asthmatics. 2. In bronchial hyperresponsiveness for methacholine, the Cmin was significantly lower in ever-smokers than in never-smokers of elderly asthmatics. 3. The generation of LB4 was significantly increased in patients with a history of smoking compared with those without a smoking history. However, the difference in LTC4 generation was not significant between ever-smokers and never-smokers of asthmatics. These results suggest that cigarette smoking increases bronchial hyperresponsiceness through IgE-mediated allergy and LTB4 generation., 高齢者喘息の病態におよぽす喫煙の影響についてはなお不明な点が多い｡本論文では,IgEにmediateされるアレルギー反応,気道過敏性,ロイコトリエンB4 (LTB4),C4(LTC4)産生に及ぼす喫煙の影響について,48例(20年以上の喫煙歴のある症例25例,非喫煙例23例)の70歳以上の高齢者喘息症例を対象に検討した｡ 1.吸入抗原に対する特異的IgE抗体の陽性頻度は,喫煙歴のある症例で,非喫煙例と比べ有意に高い値を示した｡ 2.メサコリンに対する気道過敏性の検討では,平均Cminは,喫煙例(949μg/ml)において非喫煙例(1677μg/ml)に比べ有意に低い値 を示し,喫煙例でより気道の過敏性が高いことが示された｡ 3.LTB4の産生は喫煙例で非喫煙例に比べ有意に高い傾向を示したが,LTC4に関しては両群間に有意の差は見られなかった｡以上の 結果より,長期間の喫煙は,IgEにmediateされるアレルギーやLTB4産生の亢進などを通じて気道過敏性を亢進させる可能性が示唆された｡

The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 67 patients with asthma. 1. The generation of leukotriene B4 (LTB4) by leucocytes was significantly more increased in patients with asthma than in those with pulmonary emphysema (PE) and healthy subjects. The generation of leukotriene C4 (LTC4) was also signficantly more increased in patients with asthma compared to the generation in those with PE and healthy subjects. The generation of both LTB4 and LTC4 was significantly more increased in patients with PE than in healthy subjects. 2. The generation of both LTB4 and LTC4 was larger in patients with asthma over age 70 than in those of other age groups, however, the difference was not significant. 3. The generation of LTC4 was significantly higher in attack stage than in non-attack stage in all age groups of patients with asthma, however, the generation of LTB4 was not significantly different between the two stages. 4. Bronchial hyperresponsiveness to methacholine in patients with asthma tended to decrease with aging, and the bronchial hyperresponsiveness was to a certain extent correlated with the generation of LTB4, but not LTC4. 5. The generation of LTC4 was correlated with value of FEV1.0%. These results may suggest that both LTB4 and LTC4 participate in the pathophysiology of asthma in the elderly., 気管支喘息67例を対象に, Ca ionophoreA23187刺激時の白血球からのロイコトリエンB4(LTB4)およびC4 (LTC4)の産生を観察し,高齢者喘息の臨床病態におけるLTB4,LTC4の役割について検討した｡ 1.LTB4の産生は,気管支喘息において肺気腫および健康人に比べ有意に高い値を示した｡LTC4の産生も同様に気管支喘息において,肺気腫,健康人に比べ有意に高い値30を示した｡LTB4,LTC4いずれの産生も,肺気腫症例において健康人と比べ有意に高い値が観察された。 2.LTB4,LTC4の産生は,70才以上の喘息症例において,他の年齢層の症例に比べより高い値が示されたが,推計学的な有意差は見られなかった｡ 3.高齢者を含めいずれの年齢層の気管支喘息においても,LTC4の産生は発作時に,非発作時に比べ有意の亢進が見られたが,LTB4に関しては発作時,非発作時の間に有意の差は見られなかった｡ 4.気道の過敏性は,年齢が高くなるにつれて低下する傾向が見られた｡そして,この気道の過敏性はLTB4産生とある程度関連していることが示されたが,LTC4との関連は見られなかった｡ 5.FEV1.0%値は,ある程度LTC4産生亢進と関連があることが示された｡ 以上の結果より,70才以上の喘息においても,LTB4,LTC4がその発作時病態に重要な役割を果していることが示唆された｡

Changes in the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes after spa therapy were examined in 30 patients with asthma. 1. The efficacy of spa therapy was marked in 8 (26.7%), and moderate in 16 (53.3%) of 30 patients with asthma, and slight or no efficacy of the therapy was observed in the residual 6 patients (20.0%). 2. Bronchial reactivity to methacholine was the highest in patients with slight or no efficacy of spa therapy, however. there were no significant differences among the three groups classified by clinical efficacy. 3. The generation of LTC4 was significantly higher in patients with slight or no efficacy compared with the generation in those with marked (p, 気管支喘息30例を対象に,温泉療法によるロイコトリエンB4 (LTB4),C4 (LTC4)産生の変動および気道過敏性と臨床効果との関連について検討を加えた｡ 1.温泉療法の臨床効果は,著効8例(26.7%),有効16例(53.3%),やや有 効あるいは無効6例(20.0%)であった｡ 2.メサコリンに対する気道過敏性は,やや有効あるいは無効例で高い傾向が見られたが,著効,有効例と比べ有意の差は見られなかった。 3.LTC4産生はやや有効あるいは無効例において著効例(P

Clinical effects of spa therapy were examined in 150 patients with asthma in relation tobronchial hyperresponsiveness and patient age. 1. The efficacy rate of spa therapy was larger as the patient age was higher: the rate was 73.3% in patients under age 49, 81.8% in those between the ages of 50 and 59, 86.4% in those between the ages of 60 and 69, and 90.6% in those over age 70. The mean of efficacy rates was 83.3% in all subjects. 2. The bronchial hyperresponsiveness (BH) was lower as patient age was higher: the BH in patients between the ages of 60 and 69 and in those over age 70 was significantly lower compared to the BH in those under age 49 (p < O.OOl). 3. Clinical effects of spa therapy tended to be lower in patients with increased bronchial hyperresponsiveness. The bronchial hyperresponsiveness showed a tendency to decrease after spa therapy in whom the therapy was effective, however, the BH did not change in patients with slight or no efficacy during spa therapy., 1.温泉療法では,年齢が高くなるほどその有効率も高くなると言う傾向が見られ､49才以下の症例では73.3% ,50-59才の症例では81.8% , 60-69才の症例では86.4% ,70才以上では90.6% であり,全症例の平均有効率は73.3% であった｡ 2.気道過敏性は,年齢が高くなるほど低下する傾向が見られ,60-69才および70才以上の症例の気道過敏性は,49才以下の症例と比べ有 意に低い値を示した(P < 0.001)。 3.温泉療法の臨床効果は,気道過敏性が強くなるにつれて低下する傾向が見られた｡また,温泉療法の著効例や有効例では,治療により 気道過敏性が低下してくるが､やや有効例や無効例では,気道過敏性はほとんど変化しないことが示された｡

Bronchial hyperresponsiveness was examined in relation to age, ventilatory function, and the proportion of bronchoalveolar lavage (BAL) cells in 39 patients with type Ia asthma (simple bronchoconstriction) (25 with type Ia-1 and 14 with type Ia-2), classified by clinical symptoms. 1. The proportion of BAL eosinophils was significantly higher in type Ia-2 than that in type Ia-1 asthma patients. 2. Bronchial reactivity to methacholine was not different between type Ia-1 and type Ia-2 asthma patients. 3. Bronchial hyperreactivity tended to decrease as patient age was higher in both types of asthma. Neither ventilatory function (FEV1.0%) nor the proportions of BAL lymphocytes and neutrophils was not correlated with bronchial hyperresponsiveness in both types of asthma. 4. Bronchial reactivity to methacholine more dereased with the increase in the proportion of BAL eosinophils in both type Ia-1 and Ia-2 asthma patients. The results show that bronchial hyperresponsiveness in patients with type Ia asthma is correlated to patients age and the proportion of BAL eosinophils., 気管支喘息患者Ia型(単純気管支れん縮型)39人(Ia-1型25人,Ia-2型14人)の気道過敏性を年齢,呼吸機能検査,気管支肺胞洗浄液(BAL)中の細胞成分と関連で検討を行った｡1.BAL液中の好酸球の比率はIa-1型に比べIa-2型で優位に高値であった｡2.メサコリンに対しての過敏性はIa-1型とIa-2型とで差を認めなかった｡3.気道過敏性はどちらの病型においても年齢にともなって減弱する傾向にあったが,一秒率及びBAL液中の好中球,リンパ球の比率とは相関しなかった｡4.メサコリンに対しての気道過敏性はIa-1型,Ia-2型ともにBAL液中の好酸球の比率が増加するにしたがって亢進した｡以上より単純気管支れん縮型(Ia型)の気管支喘息患者の気道過敏性はその年齢,BAL液中の好酸球の比率に相関することが示唆された｡