Eficacia de un programa de entrenamiento intradiálisis de fuerza-resistencia en combinación con electroestimulación neuromuscular: mejora en la capacidad funcional, fuerza, y calidad de vida

The purpose of this study was to determine the efficacy of a programme of strength-stamina exercises during haemodialysis, in improving muscular strength, quality of life and functional capacity to carry out everyday activities. A quantitative, experimental pre-test and post-test study was carried out. A programme of strength-stamina exercises in combination with neuromuscular electrostimulation was applied to 10 patients undergoing haemodialysis. These were three simple exercises adapted to the position in which haemodialysis was carried out. All the patients showed a significant improvement in strength, measured using functional tests to carry out everyday activities: walking (6-MWT) and sit-to-stand tests (10-STS). These tests were measured before and after the training programme. They also showed an improvement in the physical dimension of the quality of life measured using the specific questionnaire for renal patients, KDQOL-SFTM.

Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease.

Hypersensitivity pneumonitis (HP) is an immunologically mediated lung disease due to the repetitive inhalation of antigens. Most new cases arise from residential exposures, notably to birds, and are thus more difficult to recognise. The present authors report a 59-yr-old male who complained of dyspnoea and cough while being treated with amiodarone. Pulmonary function tests revealed restriction and obstruction with low diffusing lung capacity for carbon monoxide and partial pressure of oxygen. A high-resolution computed tomography chest scan and bronchoalveolar lavage showed diffuse bilateral ground-glass attenuation and lymphocytic alveolitis, respectively. Initial diagnosis was amiodarone pulmonary toxicity, but because of a rapidly favourable evolution, this diagnosis was questioned. A careful environmental history revealed a close contact with lovebirds shortly before the onset of symptoms. Precipitins were strongly positive against lovebird droppings, but were negative against other avian antigens. The patient was diagnosed with hypersensitivity pneumonitis to lovebirds. Avoidance of lovebirds and steroid treatment led to rapid improvement. The present observation identifies a new causative agent for hypersensitivity pneumonitis and highlights the importance of a thorough environmental history and of searching for precipitins against antigens directly extracted from the patient's environment. These two procedures should allow a more precise classification of some cases of pneumonitis, and thus might avoid progression of active undiagnosed hypersensitivity pneumonitis to irreversible fibrosis or emphysema.

Small airways function declines after allogeneic haematopoietic stem cell transplantation.

Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry. We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (S(acin)) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined. Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by S(acin) and forced expiratory volume in 1 s % predicted. 20 patients had abnormal S(acin) with normal spirometry, whereas none had airflow obstruction with normal S(acin). S(acin) and LCI were the only measures to change significantly between two visits, with both worsening. Change in S(acin) was the only parameter to correlate with change in chronic graft-versus-host disease grade. In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. S(acin) may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.

Comparison of two questionnaires which measure the health-related quality of life of idiopathic pulmonary fibrosis patients

The objective of the present study was to determine if there is a health-related quality of life (HRQL) instrument, generic or specific, that better represents functional capacity dysfunction in idiopathic pulmonary fibrosis (IPF) patients. HRQL was evaluated in 20 IPF patients using generic and specific questionnaires (Medical Outcomes Short Form 36 (SF-36) and Saint George's Respiratory Questionnaire (SGRQ), respectively). Functional status was evaluated by pulmonary function tests, 6-min walking distance test (6MWDT) and dyspnea indexes (baseline dyspnea index) at rest and after exercise (modified Borg scale). There was a restrictive pattern with impairment of diffusion capacity (total lung capacity, TLC = 71.5 ± 15.6%, forced vital capacity = 70.4 ± 19.4%, and carbon monoxide diffusing capacity = 41.5 ± 16.2% of predicted value), a reduction in exercise capacity (6MWDT = 435.6 ± 95.5 m) and an increase of perceived dyspnea score at rest and during exercise (6 ± 2.5 and 7.1 ± 1.3, respectively). Both questionnaires presented correlation with some functional parameters (TLC, forced expiratory volume in 1 s and carbon monoxide diffusing capacity) and the best correlation was with TLC. Almost all of the SGRQ domains presented a strong correlation with functional status, while in SF-36 only physical function and vitality presented a good correlation with functional status. Dyspnea index at rest and 6MWDT also presented a good correlation with HRQL. Our results suggest that a specific instead of a generic questionnaire is a more appropriate instrument for HRQL evaluation in IPF patients and that TLC is the functional parameter showing best correlation with HRQL.

Equações preditivas para as pressões respiratórias máximas de crianças brasileiras

I ntroduction: The assessment of respiratory muscle strength is important in the diagnosis and monitoring of the respiratory muscles weakness of respiratory and neuromuscular diseases. However, there are still no studies that provide predictive equations and reference values for maximal respiratory pressures for children in our population. Aim: The purpose of this study was to propose predictive equations for maximal respiratory pressures in healthy school children. Method: This is an observational cross-sectional study. 144 healthy children were assessed. They were students from public and private schools in the city of Natal /RN (63 boys and 81 girls), subdivided in age groups of 7-8 and 9-11 years. The students presented the BMI, for age and sex, between 5 and 85 percentile. Maximal respiratory pressures were measured with the digital manometer MVD300 (Globalmed ®). The maximal inspiratory pressure (MIP) and maximal expiratory pressures (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS Statistics 15.0 software (Statistical Package for Social Science) by assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'Student test was used for unpaired comparison of averages of the variables. The comparison of measurements obtained with the predicted values in previous studies was performed using the paired t'Student test. The Pearson correlation test was used to verify the correlation of MRP's with the independent variables (age, sex, weight and height). For the equations analysis the stepwise linear regression was used. Results: By analyzing the data, we observed that in the age range studied MIP was significantly higher in boys. The MEP did not differ between boys and girls aged 7 to 8 years, the reverse occurred in the age between 9 and 11 years. The boys had a significant increase in respiratory muscle strength with advancing age. Regardless sex and age, MEP was always higher than the MIP. The reference values found in this study are similar to a sample of Spanish and Canadian children. The two models proposed in previous studies with children from other countries were not able to consistently predict the values observed in this studied population. The variables sex, age and weight correlated with MIP, whereas the MEP was also correlated with height. However, in the regression models proposed in this study, only gender and age were kept exerting influence on the variability of maximal inspiratory and expiratory pressures. Conclusion: This study provides reference values, lower limits of normality and proposes two models that allow predicting, through the independent variables, sex and age, the value of maximal static respiratory pressures in healthy children aged between 7 and 11 years old

Função pulmonar de crianças com leucemia aguda

Introduction: The leukemias are the most common malignancy in children and adolescents. With the improvement in outcomes, there is a need to consider the morbidity to generate the protocols used in children under treatment. Aim: To evaluate pulmonary function in children with acute leukemia. Method: This study is an observational cross sectional. We evaluated 34 children distributed in groups A and B. Group A comprised 17 children with acute leukemia in the maintenance phase of chemotherapy treatment and group B with 17 healthy students from the public in the city of Natal / RN, matched for gender, age and height. The thoracic mobility was evaluated by thoracic expansion in the axillary and xiphoid levels. Spirometry was measured using a spirometer Microloop Viasys ® following the rules of the ATS and ERS. Maximal respiratory pressures were measured with digital manometer MVD300 (Globalmed ®). The maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS 17.0 software assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'student test was used to compare unpaired values found in group A with group B values, as well as with the reference values used. To compare the respiratory coefficients in the axillary level with the xiphoid in each group, we used paired testing t student. Results: Group A was significantly decreased thoracic mobility and MIP compared to group B, and MIP compared to baseline. There was no significant difference between spirometric data from both groups and the values of group A with the reference values Mallozi (1995). There was no significant difference between the MIP and MEP values and lower limits of reference proposed by Borja (2011). Conclusion: Children with acute leukemia, myeloid or lymphoid, during maintenance phase of chemotherapy treatment have reduced thoracic mobility and MIP. However, to date, completion of clinical treatment, the spirometric variables and the strength of the expiratory muscles appear to remain preserved in children between five and ten years

Effects of 12-week overground walking training at ventilatory threshold velocity in type 2 diabetic women

This study analyzed the effects of overground walking training at ventilatory threshold (VT) velocity on glycaemic control, body composition, physical fitness and lipid profile in DM2 women. Nineteen sedentary patients were randomly assigned to a control group (CG; n=10, 55.9±2.2 years) or a trained group (TG; n=9, 53.4±2.3 years). Both groups were subjected to anthropometric measures, a 12-h fasting blood sampling and a graded treadmill exercise test at baseline and after a 12-week period, during which TG followed a training program involving overground walking at VT velocity for 20-60min/session three times/week. Significant group×time interactions (P<0.05) in glycated hemoglobin (HbA1c), body mass, body mass index (BMI), peak oxygen uptake (VO 2peak) and exercise duration were observed as effects of training exercise, whereas intervention did not induced significant changes (P>0.05) in fasting blood glucose, submaximal fitness parameters and lipid profile. Our results suggest that overground walking training at VT velocity improves long term glycaemic control, body composition and exercise capacity, attesting for the relevance of this parameter as an effective strategy for the exercise intensity prescription in DM2 population. © 2011 Elsevier B.V.

Benefits of kinesiotherapy and aquatic rehabilitation on sickle cell anemia. A case report

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação funcional pré e pós programa de exercício físico de pacientes em hemodialise

Model Study: An experimental study Introduction: Chronic Kidney Disease (CKD) refers to a syndromic diagnosis which leads to a progressive and irreversible loss of renal function. A hemodialysis patient may have limitations in functional capacity, pulmonary function and respiratory musclular strength impacting in quality of life. Objective: To evaluate the effects of an exercise program on pulmonary function, functional capacity, quality of life and pain in patients undergoing hemodialysis. Methodology: The study included 28 patients of both genders, women and men aged between 40 and 60 years undergoing dialysis at the Kidney Institute, Santa Casa de Misericordia in Presidente Prudente-SP. Primary outcomes included respiratory muscular strength measurements assessed by manovacuometry. The functional capacity was evaluated by a six minute walking test. A life quality questionnaire was applied to evaluate quality of life (SF36-KDQOL). Lung function was evaluated by spirometry. Pain was assessed by a visual analogue scale. The exercise program consisted of training 3 times a week for 40 minutes on hemodialysis during eight weeks. At the end of the program all patients were reassessed. Results: There was no significant difference in the values of FVC and FEV1 before and after the exercise program as well as the index Tiffenau. The value of post MIP was significantly higher than the value obtained in the pre program. For variable MEP no significant difference was found. Functional capacity evaluations showed that there were no significant differences (p> 0.05). The evaluation of quality of life, about the domains of specific areas of CKD showed statistical significance when comparing the list of symptoms and problems with overloading of renal disease and professional role. Indicators related to pain were significantly reduced after the program (P <0.05). Discussion: A chronic kidney patient faces complex situations of physical, social and financial aspects. Although no statistically significant results were found in all variables, the study corroborates to others found in the literature, which suggests that an exercise program can be positive for this population. Conclusion: Although lung capacity and functional capacity did not submit changes to the end of the study, reduced levels of pain, fatigue and dyspnea suggest improvement in functional performance after exercise programs.

Outcome respiratorio a lungo termine nei soggetti affetti da cardiopatia congenita sottoposti ad intervento cardiochirurgico

Introduction: In the last years cardiac surgery for congenital heart disease (CHD) reduced dramatically mortality modifying prognosis, but, at the same time, increased morbidity in this patient population. Respiratory and cardiovascular systems are strictly anatomically and functionally connected, so that alterations of pulmonary hemodynamic conditions modify respiratory function. While very short-term alterations of respiratory mechanics after surgery were investigated by many authors, not as much works focused on long-term changes. In these subjects rest respiratory function may be limited by several factor: CHD itself (fetal pulmonary perfusion influences vascular and alveolar development), extracorporeal circulation (CEC), thoracotomy and/or sternotomy, rib and sternal contusions, pleural adhesions and pleural fibrosis, secondary to surgical injury. Moreover inflammatory cascade, triggered by CEC, can cause endothelial damage and compromise gas exchange. Aims: The project was conceived to 1) determine severity of respiratory functional impairement in different CHD undergone to surgical correction/palliation; 2) identify the most and the least CHD involved by pulmonary impairement; 3) find a correlation between a specific hemodynamic condition and functional anomaly, and 4) between rest respiratory function and cardiopulmonary exercise test. Materials and methods: We studied 113 subjects with CHD undergone to surgery, and distinguished by group in accord to pulmonary blood flow (group 0: 28 pts with normal pulmonary flow; group 1: 22 pts with increased flow; group 2: 43 pts with decreased flow; group 3: 20 pts with total cavo-pulmonary anastomosis-TCPC) followed by the Pediatric Cardiology and Cardiac Surgery Unit, and we compare them to 37 age- and sex-matched healthy subjects. In Pediatric Pulmonology Unit all pts performed respiratory function tests (static and dynamic volumes, flow/volume curve, airway resistances-raw- and conductance-gaw-, lung diffusion of CO-DLCO- and DLCO/alveolar volume), and CHD pts the same day had cardiopulmonary test. They all were examined and had allergological tests, and respiratory medical history. Results: restrictive pattern (measured on total lung capacity-TLC- and vital capacity-VC) was in all CHD groups, and up to 45% in group 2 and 3. Comparing all groups, we found a significant difference in TLC between healthy and group 2 (p=0.001) and 3 (p=0.004), and in VC between group 2 and healthy (p=0.001) and group 1(p=0.034). Inspiratory capacity (IC) was decreased in group 2 related to healthy (p<0.001) and group 1 (p=0.037). We showed a direct correlation between TLC and VC with age at surgery (p=0.01) and inverse with number of surgical interventions (p=0.03). Reduced FEV1/FVC ratio, Gaw and increased Raw were mostly present in group 3. DLCO was impaired in all groups, but up to 80% in group 3 and 50% in group 2; when corrected for alveolar volume (DLCO/VA) reduction persisted in group 3 (20%), 2 (6.2%) and 0 (7.1%). Exercise test was impaired in all groups: VO2max and VE markedly reduced in all but especially in group 3, and VE/VCO2 slope, marker of ventilatory response to exercise, is increased (<36) in 62.5% of group 3, where other pts had anyway value>32. Comparing group 3 and 2, the most involved categories, we found difference in VO2max and VE/VCO2 slope (respectively p=0.02 and p<0.0001). We evidenced correlation between rest and exercise tests, especially in group 0 (between VO2max and FVC, FEV1, VC, IC; inverse relation between VE/VCO2slope and FVC, FEV1 and VC), but also in group 1 (VO2max and IC), group 2 (VO2max and FVC and FEV1); never in group 3. Discussion: According with literature, we found a frequent impairment of rest pulmonary function in all groups, but especially in group 2 and 3. Restrictive pattern was the most frequent alteration probably due to compromised pulmonary (vascular and alveolar) development secondary to hypoperfusion in fetal and pre-surgery (and pre-TCPC)life. Parenchymal fibrosis, pleural adhesions and thoracic deformities can add further limitation, as showed by the correlation between group 3 and number of surgical intervention. Exercise tests were limited, particularly in group 3 (complex anatomy and lost of chronotropic response), and we found correlations between rest and exercise tests in all but group 3. We speculate that in this patients hemodynamic exceeds respiratory contribution, though markedly decreased.

Studio della funzionalità respiratoria in soggetti con sindrome di Turner

The aim of this study is to evaluate the pulmonary function in subjects with diagnosis of Turner Syndrome, in charge at the Syndromology Ward of the Paediatric Clinic of S.Orsola-Malpighi hospital. There are very few datas about lung function in patients with Turner syndrome’s genotype and phenotype in medical literature. Since the thorax of these subjects have peculiar anatomic shape (as “shield” or “overturned triangle”), we presupposed that these subjects could have also a peculiar respiratory function. Moreover we look for the possibility of correlation between pulmonary function and estroprogestinic replacement therapy and/or growth hormone (GH) replacement therapy. Material and methods: we studied 48 patients, with diagnosis of Turner Syndrome; they all made spirometry voluntarily and, when capable, also plethismografy. Results: - the parametres of pulmonary function are a little higher of the predicted values for age and sex but they are a little lower if they're corrected for each patient’s ideal high and weight: so we can conclude that in Turner Syndrme subjects pulmonary function is normal; -there’s not a statistically significant correlation between pulmonary function and GH therapy; -there’s not a statistically significant correlation between GH therapy’s length and pulmonary function except for Total Lung Capacity which increases with the number of years of GH therapy; - there’s not a statistically significant correlation between pulmonary function and estroprogestinic replacement herapy.

Increased uptake of 111In-octreotide in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is characterized by an uncontrolled accumulation and activation of lung fibroblasts. A modulation of fibroblast activation has been observed in various systems with octreotide, a synthetic somatostatin analog with strong affinity for the somatostatin receptor subtype 2 (sst2). One aim of our study was to evaluate the expression of somatostatin receptors in the lungs of patients with IPF. A second aim was to evaluate the relationship between 111In-octreotide uptake and the effect of pulmonary fibrosis as assessed by lung function tests and parameters and by radiologic findings. METHODS: We investigated 11 patients with IPF, 6 patients with pulmonary fibrosis associated with systemic sclerosis (SSc), and 19 patients with disease not of the lung (control patients). The expression of somatostatin receptors was evaluated in vivo using 111In-octreotide scintigraphy. We evaluated the relationship between 111In-octreotide uptake and the activity of pulmonary fibrosis as assessed by lung function tests, bronchoalveolar lavage (BAL) cellularity, and high-resolution CT (HRCT) of the chest. Planar images and thoracic SPECT (24 h) were performed after injection of 222 MBq of 111In-octreotide. Lung uptake was quantified using the lung-to-background ratio (L/B). In addition, the expression of sst2 was evaluated in vitro, in frozen lung-tissue samples using autoradiography, and in human cultures of lung fibroblasts using a ligand-binding assay. RESULTS: Compared with lung uptake in control patients (median L/B, 1.25; range, 1.14-1.49), lung uptake was increased in all 11 IPF patients (median L/B, 2.63; range, 1.59-3.13; P < 0.001) and in 4 of 6 SSc patients (median L/B, 1.68; range, 1.42-2.16). The L/B was lower in SSc patients than in IPF patients (P = 0.011). Increased uptake correlated with the alteration of lung function (carbon monoxide diffusing capacity [rho = -0.655; P = 0.038], diffusing capacity for carbon monoxide and alveolar volume ratio [rho = -0.627; P = 0.047], vital capacity [rho = -0.609; P = 0.054], and total lung capacity [rho = -0.598; P = 0.058]) and with the intensity of alveolitis (total BAL cellularity [rho = 0.756; P = 0.045], neutrophil counts [rho = 0.738; P = 0.05]), and HRCT fibrosis score (rho = 0.673; P = 0.007). Autoradiography suggested that vascular structures were a prominent binding site. Lung fibroblasts expressed somatostatin receptors in vitro as measured by binding assay. CONCLUSION: Our preliminary results identified an increased expression of sst2 in (mainly idiopathic) pulmonary fibrosis. Lung uptake correlates with the alteration of lung function and with the intensity of alveolitis.

Avaliação da musculatura inspiratória e expiratória na doença pulmonar obstrutiva crônica leve e grave comparada aos indivíduos saudáveis

Introdução: A DPOC é uma doença respiratória prevenível e tratável, caracterizada por limitação persistente ao fluxo aéreo, hiperinsuflação e aprisionamento aéreo. A dispneia e a intolerância aos esforços, decorrentes destas alterações fisiopatológicas sofre influência de vários fatores. Dentre estes, o recrutamento e a sobrecarga imposta aos músculos inspiratórios e expiratórios são de fundamental importância, porém a participação destes ainda não foi completamente elucidada em diferentes gravidades da doença. Objetivos: O objetivo principal deste estudo foi avaliar a mecânica ventilatória, e o grau de recrutamento da musculatura inspiratória e expiratória na DPOC leve e grave, na condição de repouso e durante um teste máximo de exercício, comparado a um grupo de indivíduos saudáveis. Metodologia: Trata-se de um estudo transversal envolvendo 36 indivíduos, sendo 24 pacientes portadores de DPOC e 12 voluntários sadios. As avaliações foram divididas em 2 visitas. No D1, foram realizadas uma avaliação clínica, avaliação de dispneia (mMRC) e de qualidade de vida (SGRQ), além da prova de função pulmonar completa. Na 2ª visita, realizada com intervalo de 1 semana, foram avaliadas: as pressões respiratórias máximas estáticas por meio de métodos volitivos (PImax, PEmax, SNIP, Pes sniff, Pga sniff e Pdi sniff) e não volitivos (Twitch cervical bilateral e T10); avaliação da sincronia toracoabdominal por pletismografia de indutância; avaliação do recrutamento dos músculos inspiratórios e expiratórios ao repouso pela eletromiografia de superfície; e, posteriormente, um teste de exercício cardiopulmonar incremental para estudo de todas essas variáveis no esforço. Resultados: Foram avaliados 24 pacientes (12 leves e 12 graves) e 12 indivíduos saudáveis da mesma faixa etária. A maioria dos pacientes apresentava comprometimento significativo da qualidade de vida e os pacientes do grupo grave eram mais sintomáticos. A função pulmonar encontrava-se alterada na maioria dos pacientes. Destes, 79,2% apresentavam aprisionamento aéreo e 70,8% tinham redução da DLCO. Tais alterações foram semelhantes nos 2 grupos de pacientes. A força muscular estática medida por métodos volitivos e não volitivos estava reduzida nos 2 grupos e mostrou relação com o VEF1. No exercício, a dispneia foi o principal motivo para interrupção do teste em 70% dos pacientes. A HD esteve presente em 87,5% dos pacientes. O comportamento das pressões respiratórias foi significativamente diferente entre os 3 grupos. Os pacientes com DPOC apresentaram maior atividade diafragmática (Pdi) comparado aos controles e a participação da musculatura expiratória também foi maior neste grupo, principalmente nos graves. Apesar disso, os pacientes com DPOC apresentaram uma eficiência mecânica reduzida, ou seja, esse incremento da força muscular foi insuficiente para manter uma ventilação adequada para uma determinada carga. Com o aumento da demanda ventilatória, houve recrutamento precoce e progressivo dos músculos inspiratórios e expiratórios durante o exercício. O trabalho resistivo e o expiratório foram significativamente diferentes entre os controles e os pacientes com DPOC desde o início do exercício. Como consequência destas alterações, a intensidade da dispneia durante o TECP foi maior nos pacientes com DPOC (leve e grave) para a mesma carga e mesma ventilação-minuto (VE), quando comparada aos indivíduos do grupo-controle. Conclusões: O conjunto destes achados demonstra que o comprometimento dos músculos inspiratórios e expiratórios contribuiu significativamente para a dispneia e a intolerância ao exercício tanto no DPOC leve quanto no DPOC grave. E que este comprometimento pode não ser detectado com os testes máximos de força ao repouso

The impact of ageing on the barriers to drug delivery

Generally, we like to see ageing as a process that is happening to people older than ourselves. However the process of ageing impacts on a wide range of functions within the human body. Whilst many of the outcomes of ageing can now be delayed or reduced, age-related changes in cellular, molecular and physiological functionality of tissues and organs can also influence how drugs enter, distribute and are eliminated from the body. Therefore, the changing profile of barriers to drug delivery should be considered if we are to develop more age-appropriate medicines. Changes in the drug dissolution and absorption in older patients may require the formulation of oral delivery systems that offer enhanced retention at absorption sites to improve drug delivery. Alternatively, liquid and fast-melt dosage systems may address the need of patients who have difficulties in swallowing medication. Ageing-induced changes in the lung can also result in slower drug absorption, which is further compounded by disease factors, common in an ageing population, that reduce lung capacity. In terms of barriers to drug delivery to the eye, the main consideration is the tear film, which like other barriers to drug delivery, changes with normal ageing and can impact on the bioavailability of drugs delivery using eye drops and suspensions. In contrast, whilst the skin as a barrier changes with age, no significant difference in absorption of drugs from transdermal drug delivery is observed in different age groups. However, due to the age-related pharmacokinetic and pharmacodynamic changes, dose adaptation should still be considered for drug delivery across the skin. Overall it is clear that the increasing age demographic of most populations, presents new (or should that be older) barriers to effective drug delivery. © 2012 Elsevier B.V. All rights reserved.