For adults, pneumococcal vaccination may be more cost-effective with the 13-valent conjugate, formerly reserved for children (Prevnar 13), than with the currently recommended 23-valent version (Pneumovax 23), according to a modeling study.

The cost per quality life-year gained was estimated at $28,900 with the 13-serotype vaccine (PCV13) compared with $34,600 with the 23-serotype polysaccharide vaccine (PPSV23), said Kenneth J. Smith, MD, of the University of Pittsburgh, and colleagues.

Those numbers were in the range considered to be moderately good evidence for adoption of an intervention, although changing some assumptions about efficacy of the newer vaccine eliminated its advantage, the group reported in the Feb. 22/29 issue of the Journal of the American Medical Association.

"PCV13 might prevent more pneumococcal disease compared with current PPSV23 vaccination recommendations while remaining economically reasonable," they concluded.

The conjugate vaccine covers the 13 bacterial serotypes that account for most invasive pneumonia. It replaced the seven-valent version used for children in 2010 and gained an expanded indication for the 50 and older population just last month.

Nearly two-thirds of women who develop asthma as adults have a nonallergic form of the disease compared with just one-third of men, report Bénédicte Leynaert (INSERM Unité 700, Paris, France) and colleagues in Thorax.

"Although women with severe nonallergic asthma may represent a substantial proportion of adults with asthma in clinical practice, gender differences in the incidence of allergic and non-allergic asthma have been little investigated in the general population," say the researchers.

To address this, they evaluated gender differences in asthma prevalence and incidence among 9091 men and women randomly selected from the general population in 14 different countries. The individuals, who were participants of the European Community Respiratory Health Survey, were followed up after 8-10 years. Bronchial responsiveness, immunoglobulin (Ig)-E specific to four common allergens, and skin test reactivity to nine allergens were measured in all participants at baseline.

The researchers report that there was no gender difference in the prevalence of asthma at baseline among participants aged 20-35 years. However, women were a significant 21% more likely to have asthma than men after age 35 years, and the difference was consistent across participating centers, despite geographic variations in the prevalence of asthma.

Sleep-disordered breathing, especially obstructive sleep apnea (OSA), has a high prevalence among the elderly, where it may present with atypical symptoms. Untreated OSA can reduce quality of life and have adverse health consequences.

Effective treatment is available, so all physicians treating the elderly should be aware of the clinical presentation, diagnostic methods, and treatment options for OSA.