Respiratory investigation最新文献

Background: The mean age at diagnosis of sarcoidosis has been increasing worldwide, yet the clinical characteristics and treatment patterns of elderly-onset cases remain insufficiently defined, particularly in Asian populations.

Methods: We retrospectively investigated 187 consecutive Japanese patients newly diagnosed with sarcoidosis at Jichi Medical University Hospital between 2006 and 2018 who fulfilled the 2015 diagnostic criteria. Patients were classified as elderly (≥65 years, n = 49), middle-aged (45-64 years, n = 82), or younger (<45 years, n = 56). Organ involvement was assessed based on the 2023 Japan Society of Sarcoidosis and Other Granulomatous Disorders standards and the 2014 WASOG criteria. The frequency and distribution of systemic therapy (corticosteroids, methotrexate, other immunosuppressants) and treatment indications were compared across age groups.

Results: The proportion of women was significantly higher in the elderly than in the younger group (81.6% vs. 41.1%, p < 0.01), as was the frequency of cardiac involvement (12.2% vs. 3.6%, p < 0.05). Systemic therapy was initiated less often in the elderly than in the middle-aged group (10.2% vs. 25.4%, p = 0.026), and all indications involved extrapulmonary lesions (cardiac, n = 3; neurological, n = 1; ocular, n = 1). Most treated patients received systemic corticosteroids, with a median duration of 7.0 months.

Conclusion: Elderly-onset sarcoidosis in Japan was characterised by a predominance of women and a higher frequency of cardiac involvement. Systemic therapy was infrequently initiated and only for extrapulmonary disease. These findings underscore the need for systematic evaluation of extrapulmonary organs-particularly the heart-and age-adapted multidisciplinary management.

Background: Olfactory stimulation with L-menthol may reduce certain discomfort sensations, including dyspnea. Chronic obstructive pulmonary disease (COPD) and idiopathic interstitial pneumonias (IIPs) have distinct physiological characteristics and may elicit different qualitative sensations of dyspnea. Therefore, the qualitative effects of L-menthol inhalation on dyspnea may differ between these chronic lung diseases (CLDs). This study aimed to determine which aspects of dyspnea are influenced by olfactory stimulation with L-menthol in patients with CLDs.

Methods: Thirty-four patients with stable COPD or IIPs (17 each) performed a 6-min walk test (6MWT) under two conditions: wearing a surgical mask alone (control) or wearing a mask with a peppermint oil aroma sticker (0.105 ml, containing 30% L-menthol). A modified Borg scale, the Multidimensional Dyspnea Profile (MDP), and the Language of Dyspnea Questionnaire (LDQ) were used to evaluate endpoints. The 6MWT was selected to induce breathlessness with and without L-menthol.

Results: In the COPD group, L-menthol significantly improved Mental breathing effort on the MDP, and Rapid, Gasping, and Air hunger on the LDQ. In the IIPs group, L-menthol improved only the MDP Hyperpnea dimension. No significant differences were observed in the modified Borg scale before and after the 6MWT between L-menthol and control conditions in either group.

Conclusions: Olfactory stimulation with L-menthol selectively improved aspects of dyspnea in patients with COPD and IIPs, likely reflecting differences in the pathophysiology and severity of each disease.

Trial registration: Japan Registry of Clinical Trials (jRCTs031200400).