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Biomedical subjects

M J Connolly

Publications and source records attributed to M J Connolly.

At least 37 records · Page 2Linked to original sources
PubMed1998

Elderly people at home disabled by chronic obstructive pulmonary disease.

BACKGROUND: We compared uptake of hospital and community-based support in elderly people disabled by chronic obstructive pulmonary disease (COPD), normal controls (NCs) and patients with Parkinsons disease, stroke, amputation, or arthritis (disabled controls; DCs). METHODS: There were 65 subjects (35 men) aged 70-93 years (mean 78) with COPD, 55 NCs [23 men; age range 71-90 years (mean 78)] and 53 DCs [27 men; age range 70-92 years (mean 78)]. Patients with COPD and DCs were outpatients with Nottingham extended activities of daily living (NEADL) score < 16. NCs came from a community survey. Subjects with COPD were clinically stable. All were cognitively intact. RESULTS: Mean NEADL scores (and range) were: 10.2 (3-15) for patients with COPD, 9.4 (3-15) for DCs (t=1.14, P=0.26) and 19.0 (11-21) for NCs. There was no difference in meals-on-wheels, district nurse or hospital or physiotherapy provision between patients with COPD and NCs, but those with COPD received more home care (P < 0.01). DCs received more home care (P=0.04), more district nurse input (P < 0.001) and more physiotherapy (P < 0.0001) than those with COPD. CONCLUSIONS: Despite moderate or severe disability, elderly patients with COPD receive little statutory domiciliary support. Reasons for this need further exploration.

Activities of Daily Living↗
PubMed1998

The effect of walking aids on exercise capacity and oxygenation in elderly patients with chronic obstructive pulmonary disease.

BACKGROUND: high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease (COPD). We have assessed the effect of Zimmer, rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD. METHODS: 27 out-patients (15 men) aged 70-82 (mean 75) years were recruited. Exclusions comprised: COPD exacerbation or oral steroid use within 6 weeks, confusional state, participation in a pulmonary rehabilitation programme and exercise limitation by other diseases. Subjects completed 6-min walk tests unaided and with the three frames on four separate days in random order 30 min after nebulized salbutamol (5 mg) and ipratropium (0.5 mg) and were accompanied by an investigator blinded to results of all other walk tests undertaken. Oxygen saturation (SaO2) was monitored by finger probe during exercise. Grouped t-tests were used to compare distances and reductions in SaO2. RESULTS: Unaided, the mean (SEM) 6-min walk distance was 210 (16) m and fall in oxygen saturation was 6.0 (1.1)%. Use of a rollator frame did not significantly affect either of these values. Using the Zimmer frame reduced the mean distance to 165 (13) m (t=5.2, P < 0.001 vs unaided walk) with an SaO2 fall similar to that recorded during the unaided walk. Using the gutter frame increased the mean distance to 234 (150) m (t=3. 1, P=0.004 vs unaided walk) and reduced the fall in SaO2 to 3.7 (0.8)% (t=2.3, P=0.03 vs unaided walk). CONCLUSIONS: gutter frames improve exercise capacity and SaO2 during exercise in elderly COPD patients who remain symptomatic on optimal therapy, whereas unwheeled Zimmer frames have a deleterious effect in such patients.

Aged↗
PubMed1997

Persistence of atopic effects on airway calibre and bronchial responsiveness in older adults.

BACKGROUND: the relationships between atopy and chronic airflow obstruction and bronchial hyperresponsiveness in adults are unclear. We measured airways calibre (FEV1), bronchial responsiveness, eosinophil count and total serum IgE in a random population sample of adults aged 45 years or older. METHODS: Caucasian adults (n = 783) were selected from the practice lists of local general practitioners using random number tables. Responders to a postal questionnaire were invited to attend for venous blood sampling and methacholine challenge (Newcastle dosimeter method). FINDINGS: the questionnaire response rate was 92.3% (723 subjects); 62.5% of subjects invited to attend did so. Attenders were slightly younger than the whole study population, but otherwise representative. Methacholine challenge was completed by 208 subjects. Geometric mean IgE level was higher in current smokers; both IgE and eosinophils were raised in subjects reporting asthma. Multiple regression showed a negative independent relationship between age- and sex-standardized eosinophils and baseline FEV1 and a positive relationship between standardized IgE score and level of bronchial responsiveness. Separate analysis of subjects aged <65 and > or =65 years showed that these relationships were only significant in older subjects. INTERPRETATION: airways calibre and level of bronchial responsiveness are associated with measures of atopy in older adults. Atopy should not be overlooked as a factor in elderly patients with asthma or chronic airflow obstruction.

Age Factors↗
PubMed1996

Factors affecting oxygen saturation during methacholine challenge in a mixed population.

Bronchial challenge with methacholine or histamine is associated with a reduction in arterial oxygen tension, which can be appreciable. In this study, oxygen saturation was monitored during methacholine challenge in subjects with and without respiratory disease, over a wide age range, in order to identify factors predicting a large fall in saturation during the challenge. Two hundred and twenty subjects aged 24-86 years were included, comprising 15 healthy adult volunteers, and 205 adults from a random sample of the local adult population taking part in a survey of bronchial responsiveness. Subjects with ischaemic heart disease or baseline FEV1 < 60% predicted were excluded. Methacholine challenge was performed by the Newcastle Dosimeter technique; oxygen saturation (SaO2) was monitored using a pulse oximeter and finger probe. Of the 220 subjects, 27% were current smokers and 39.5% were ex-smokers; 26% reported asthma or bronchitis. Mean baseline FEV1 was 100% predicted; mean baseline saturation was 97%. Mean fall in saturation was 3.2% (range 0-17.5%). Multiple regression analysis revealed that fall in saturation during methacholine challenge is related to baseline FEV1, baseline SaO2, log of total methacholine dose inhaled, and fall in FEV1 during challenge. Change in saturation was not related to subject age, smoking history, reported asthma or bronchitis, or the presence of respiratory symptoms. Methacholine challenge produces a significant fall in oxygen saturation, but this is not greater in subjects who are old or have low baseline saturation.

Adult↗
PubMed1996

Respiratory rehabilitation, exercise capacity and quality of life in chronic airways disease in old age.

Respiratory rehabilitation improves exercise capacity and quality of life in younger patients but is untried in the aged. We aimed to: (a) assess repeatability of the 6-minute walk test, factors affecting it and its relation to quality of life in elderly patients with chronic obstructive airways disease (COAD); (b) assess compliance of such patients with an intensive respiratory rehabilitation protocol; (c) pilot the assessment of the effect of respiratory rehabilitation on the 6-minute walk test in these patients. Seventeen subjects with stable, symptomatic COAD were recruited, 15 (six men), 70-89 (mean 76) years, completed the study. Mean (standard deviation) 1-second forced expiratory volume (FEV1) = 49 (5)% predicted. Six-minute walk tests were repeated single-blind, 2-10 days apart. Quality of life was measured using Guyatt respiratory questionnaire. Patients underwent 12 weeks incremental respiratory rehabilitation (x4/day step-ups, unweighed arm raises, inflating balloons). Baseline 6-minute walk was repeatable and was correlated with the log Guyatt dyspnoea score (r = 0.65, p = 0.006). In multiple regression neither age nor FEV1 predicted walk distance: body mass index, maximal expiratory mouth pressure; calorie intake. Mean (SEM) 6-minute walk distance after-rehabilitation was greater than baseline (p = 0.003). Elderly patients with COAD tolerate intensive respiratory rehabilitation and a controlled, blinded study is needed.

Aged↗
PubMed1996

Prevalence and treatment of chronic airways obstruction in adults over the age of 45.

BACKGROUND: Chronic airways obstruction is common in adults and the elderly. To investigate the possibility that older adults with obstructive airways disease frequently do not receive appropriate treatment, the respiratory symptoms, medication use, and pulmonary function were studied in a random sample of white adults aged over 45 living in central Manchester, UK. METHODS: A postal questionnaire survey was performed on 783 men and women aged 45 years and over selected from GP lists by random number tables. Subjects completing the questionnaire were invited to attend for pulmonary function testing and methacholine challenge (Newcastle dosimeter method). RESULTS: The questionnaire response rate was 92.3% (723 subjects). The mean age of the population was 66.1 years and 57.2% were women; 29.2% were current smokers and 37.3% were ex-smokers. Asthma or bronchitis was reported by 30.0%. Two hundred and forty seven representative subjects attended for pulmonary function testing and spirometric evidence of chronic airways obstruction was found in 26.4%. Respiratory symptoms were reported by 76.6% of subjects with chronic airways obstruction; 55.0% had features which may predict potential improvement on treatment (increased non-specific bronchial responsiveness or significant bronchodilator reversibility). However, only 55.4% of subjects with airways obstruction had received a diagnosis of asthma or chronic bronchitis and only 36.9% were using inhaled bronchodilators or steroids. CONCLUSIONS: Chronic airways obstruction is very common in adults in this inner city population, but is frequently overlooked. Most subjects with chronic airways obstruction are not receiving appropriate treatment.

Aged↗
PubMed1996

Impact of obstructive airways disease on quality of life in older adults.

BACKGROUND: Obstructive airways disease adversely affects quality of life, although relationships between quality of life and lung function have been shown to be weak. The relationships between the results of a quality of life questionnaire, spirometric tests, and methacholine bronchial challenge were investigated in a population sample of middle aged and elderly people. METHODS: A random population sample of the white population of Central Manchester, UK were contacted by post. Respondents were invited to undergo bronchial challenge with methacholine (Newcastle dosimeter method) and to complete the St George's Respiratory Questionnaire. This self-completed questionnaire quantifies quality of life as three component scores, with higher scores indicating greater impairment of quality of life. RESULTS: Two hundred and twenty seven subjects aged 45-86 years completed the St George's Questionnaire and performed spirometric tests; 190 completed the methacholine challenge. All quality of life scores were higher in subjects with a forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) of < 65%, indicating impaired quality of life in subjects with airways obstruction. There was no relationship between quality of life and age. Multiple regression analysis showed independent relationships between quality of life scores and both baseline FEV1 and bronchial responsiveness. However, the amount of variation in quality of life attributable to variation in FEV1 or bronchial responsiveness was less than 10%. Subgroup analysis indicated that the quality of life score was independently associated with bronchial responsiveness and not FEV1 in subjects aged < 65 years, but with baseline FEV1 and not bronchial responsiveness in older subjects. CONCLUSIONS: Obstructive airways disease significantly impairs quality of life in adults. The reduction in quality of life in these patients is related to both baseline pulmonary function and non-specific bronchial responsiveness. The impact of airways obstruction on quality of life does not decrease with advancing age.

Age Factors↗
PubMed1995

Inhaler technique of elderly patients: comparison of metered-dose inhalers and large volume spacer devices.

Large volume spacers (LVSs) reduce systemic absorption of steroid from metered-dose inhalers (MDIs) but there are no data to support the widespread belief that LVSs are easy for older people to use. MDI and LVS technique was examined in 40 inhaler-naive patients [19 men; 70-92 (mean 78.3) years] with chronic airways disease and mental test scores > 7/10. On day 1, technique was taught and errors corrected if possible. Technique was scored and patients asked which device they preferred. They were prescribed the device with which they were most competent. Those competent with both were given a device randomly. Technique was reassessed on day 29 without further tuition. On day 1 only three patients (8%) had inadequate technique for LVS vs. 12 (30%) for MDI (chi 2 = 6.90; p = 0.032). The main problems were inability to trigger the device (two patients with both devices), problems co-ordinating triggering and inhalation (20 patients with MDI), problems inserting the MDI into the LVS (seven patients), and unnecessary repetitive firing of the LVS (three patients); 28 (70%) preferred LVSs. On day 29, 29/30 (97%) with LVSs used them adequately, as did 13/15 (87%) using MDIs (five patients used both). LVSs have advantages over MDIs for elderly patients in terms of patient preference and inhaler technique.

Adrenal Cortex Hormones↗
PubMed1995

Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke.

We have assessed the measurement of oxygen saturation (SaO2) as a means of detecting aspiration in patients with stroke. For 10 weeks all acute stroke [AS] admissions were seen within 48 hours. Basal SaO2 was measured by pulse oximetry. Patients swallowed 10ml water while sitting up and SaO2 was noted for 2 minutes. Two control groups [young, fit (YF) and inpatient age- and sex-matched, non-neurological disease (IP)] underwent the same assessment. AS subjects underwent independent assessment of swallowing by a speech and language therapist (SLT). Exclusion criteria comprised impaired consciousness, other neurological disease and chest infection. Forty-nine AS subjects [20 men; aged 46-93 (mean 71) years], 55 YF [26 men; aged 18-55 (mean 32) years] and 65 IP [28 men; aged 53-96 (mean 71) years] were studied. Mean (SD) SaO2 fall in AS subjects [2.6 (2.9)%)] was significantly more than in YF [1.1 (0.8)%] or IP [1.1 (0.9)%]. The lower 95% confidence limit for variation in SaO2 did not differ between YF and IP (3.0% 'fall'); 19 (39%) AS subjects desaturated below this 95% lower confidence limit. Mean (SD) SaO2 fall was significantly more in SLT-graded 'aspirators' [4.6 (2.7)%] than 'nonaspirators' [1.4 (1.0)%]. We conclude that (1) a fall in SaO2 on swallowing fluid is common in patients with acute stroke; (2) the presence or absence of desaturation agrees statistically with SLT assessment of aspiration; (3) SaO2 measures may aid bedside assessment of swallowing.

Adolescent↗
PubMed1995

Effects of diurnal variation and prolonged refractoriness on repeated measurements of airways responsiveness to methacholine.

BACKGROUND: A number of studies have suggested that diurnal variation in airways responsiveness underlies the circadian rhythm of ventilatory function in asthma. Measurements of airways responsiveness are therefore often performed at standardised times in order to avoid this possible effect, but this is not practical for epidemiological studies. Refractoriness to methacholine has also been reported and this, too, could confound the results of methacholine tests repeated over short intervals. This investigation was carried out to evaluate the possible magnitude of diurnal variation and refractoriness in repeated measures of airways responsiveness to methacholine. METHODS: To investigate diurnal variation in airways responsiveness, 24 asthmatic subjects aged 18-45 underwent five methacholine tests over three days which were not necessarily consecutive: day 1 at 08:00 hours; day 2 at 08:00 hours, 14:00 hours, 20:00 hours; day 3 at 20:00 hours. To investigate refractoriness a retrospective analysis was undertaken of all paired methacholine tests performed in individuals within our unit between 1984 and 1990 where there had been no intervention likely to affect the results. RESULTS: The first investigation revealed no diurnal change in airways responsiveness although there was a change in FEV1. Mean PD20 did, however, increase 1.57 fold from 08:00 hours on day 1 to 08:00 hours on day 2 for subjects studied on consecutive days. The second investigation confirmed that a test interval of up to 24 hours (but not of 48 or more hours) was associated with a refractory index (PD20 test 2/PD20 test 1) of > 1. CONCLUSIONS: No diurnal variation in airways responsiveness was detected for measurements made between 08:00 hours and 20:00 hours, but an interval between successive tests of up to 24 hours was associated with refractoriness. Diurnal variation is not likely to exert an important confounding effect on methacholine tests carried out between 08:00 hours and 20:00 hours, but confounding could result from refractoriness if tests are repeated at intervals up to 24 hours.

Adult↗
PubMed1995

Impaired bronchodilator response to albuterol in healthy elderly men and women.

BACKGROUND: Lymphocytes of normal elderly subjects and young asthmatics display dysfunctional beta-adrenoceptors. If beta-adrenoceptor dysfunction were found in senescent airways, it might help explain the pathogenesis of late onset asthma. METHODS: The bronchodilatory effects of albuterol after methacholine-provoked bronchoconstriction were compared in 17 healthy young (age 20 to 36 years) and 17 healthy elderly (age 60 to 76 years) volunteer subjects. Albuterol was inhaled via dosimeter (initially 7.8 micrograms, doubling every 7.5 min) with forced expiratory flow at 50% vital capacity (FEF50) measured prior to each dose. Albuterol sensitivity was expressed as the cumulative logarithm of the area under the FEF50 recovery curve (AUC); a greater AUC meant lower sensitivity. On another study day, spontaneous recovery from methacholine was assessed similarly. RESULTS: There was no intergroup difference in spontaneous recovery. Despite lower methacholine doses provoking similar (35%) FEF50 falls in elderly subjects, albuterol AUC was greater in elderly subjects (6,552%.min.microgram) than young subjects (3,922%.min microgram; p = 0.03). Multiple regression showed that AUC and age were related (p = 0.02). CONCLUSION: Airway beta 2-adrenoceptor responsiveness is diminished in old age, suggesting that airway beta-adrenoceptor dysfunction may be implicated in late-onset asthma.

Adult↗
PubMed1994

Auditory problems in elderly patients with stroke.

Twenty-five CAT-scan-confirmed stroke patients and 25 matched controls were studied. All the stroke patients were stable 2-3 months after unilateral hemispheric stroke. Those with ear disease, other central neurological disorder, severe dysphasia and acute or chronic confusion were excluded. There were no significant differences between the groups for average pure tone hearing threshold (APTT) or ability to discriminate pre-recorded speech presented to one ear at 35 decibels (dB) above APTT. The stroke subjects had significantly impaired performance on dichotic competing sentence testing (DCST). Seventeen stroke patients but only one control subject failed DCST. Failure rate was similar for left and right stroke and for temporal and non-temporal lobe involvement. Two-thirds of patients failing DCST did so in the ear opposite the side of the cortical lesion. We conclude that (i) DCST is useful in detecting central auditory dysfunction in stroke patients; and (ii) stroke can affect central auditory perception in older patients.

Aged↗
PubMed1994

Peripheral mononuclear leucocyte beta adrenoceptors and non-specific bronchial responsiveness to methacholine in young and elderly normal subjects and asthmatic patients.

BACKGROUND: As beta adrenoceptor dysfunction occurs in both the normal elderly subject and in young asthmatic patients, the hypothesis was examined that age related beta adrenoceptor changes are important in the pathogenesis of late onset asthma in old age. METHODS: Subjects were non-smokers who comprised 17 young normal subjects of mean (SE) age 29.4 (1.3) years, 17 elderly normal subjects of 67.2 (1.3) years, seven young asthmatic patients of 31.0 (2.8) years, and 17 elderly asthmatic patients of 68.5 (1.4) years. All asthmatic patients withheld inhalers for 12 hours and oral treatment for 24 hours before each study day. Subjects underwent an inhaled methacholine challenge (Newcastle dosimeter method) on two nonconsecutive days. The slope of the flow at 50% of the vital capacity (FEF50) dose-response curve was derived from the percentage fall in FEE50 divided by methacholine dose (sFEF50). Beta-adrenoceptor density (Bmax) and affinity (%KH) were determined with (125I)iodocyanopindolol as the radioligand in membranes prepared from mononuclear leucocytes. RESULTS: Log sFEF50 was shown to be reproducible (repeatability coefficient 0.41) on the two study days and was inversely related to %KH but not to Bmax. Multiple regression analysis (all 58 subjects, overall R2 = 0.57) revealed an inverse relation between log sFEF50 and %KH, and between log sFEF50 and Bmax. The inverse relation between log sFEF50 and %KH was preserved whereas that between log sFEF50 and Bmax was lost when young asthmatic subjects or when all asthmatic subjects were excluded from multiple regression analysis. CONCLUSIONS: The beta adrenoceptor dysfunction observed in late onset asthma may be similar to that seen during ageing. Thus late onset asthma may represent the extreme of a spectrum of age associated beta adrenoceptor dysfunction.

Adolescent↗