Clodagh M. Ryan, MD MRCPI, Assistant Professor of Medicine, Division of Respirology, University Health Network / University of Toronto, Toronto, ON.

Chronic cough is defined as a cough that persists longer than eight weeks. It is one of the most frequent complaints of patients attending physicians’ outpatient clinics. Contrary to popular belief, the diagnosis and treatment of the majority of patients can be achieved by following an empiric, integrative approach. As chronic cough may be responsible for significant deterioration in quality of life, successful management and treatment is important for individual patients. Unfortunately, failure to adequately manage chronic cough is usually due to physician ignorance of the current diagnostic algorithms, which pertain as much to older as to younger adults.
Key words: chronic cough, older adults, upper airway cough syndrome, reflux disease, asthma.

Sidney S. Braman, MD, FACP, FCCP, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Brown Medical School & Rhode Island Hospital, Providence, RI, USA.

Asthma is an inflammatory disease of the airways manifested by diffuse airflow obstruction, complete or partial reversibility of the airflow obstruction, and bronchial hyper-responsiveness. Asthma may occur at any age and is more prevalent in older compared to younger adults. Unfortunately, the diagnosis of asthma is frequently overlooked as patients underreport their symptoms, physicians underutilize pulmonary function testing, and symptoms are mistaken for other diseases such as COPD and heart failure. The medications used to treat the older asthmatic are effective, well tolerated, and the same as those used to treat younger patients.
Key words: asthma, reversible airflow obstruction, airway remodelling, beta-agonist therapy, inhaled corticosteroids.

Joyce So, BSc

Despite growing concerns about air pollution, environmental tobacco smoke, and actions taken to reduce them, the incidence of asthma in North America has continued to rise since the 1970s.^1,2 It is estimated that about 4 to 5% of the general population suffers from asthma.¹ Asthma is a chronic inflammatory disease of the airways triggered by allergens and other stimuli, which lead to episodes of bronchial hyper-responsiveness and obstruction of airflow. Common signs and symptoms of asthma include recurrent wheezing, coughing, difficulty breathing and chest tightness. These symptoms often occur or worsen at night, during exercise, or in the presence of viral infection and common allergens such as dust, pets, pollen and smoke.

In the elderly, studies have shown that advanced age, male gender, parental history of chronic airway disease or hay fever, history of childhood respiratory illness, and environmental tobacco smoke exposure are all risk factors for developing asthma.1 In addition, various studies have established a clear association between bronchospasmic exacerbation and air pollution, with increased incidence of obstructed airways and hospital emergency department admissions for asthma in polluted, urban regions.