Key messages * Poor cognitive performance has been associated with increased mortality in several studies of elderly people, but the underlying mechanisms are unclear * In this prospective study of 921 elderly people cognitive impairment was a strong predictor of death from ischaemic stroke * Low vitamin C intake and low plasma ascorbate concentrations were also important risk factors for death from stroke * Cognitive performance was poorest in people with the lowest vitamin C status * A high vitamin C intake may protect against both cognitive impairment and cerebrovascular disease showed that intake of the antioxidant vitamin C was a strong predictor of subsequent death from stroke.8 This finding, together with the known link between atherosclerosis and cognitive impairment, suggests that subclinical deficiency of vitamin C may be a determinant rather than a consequence of impaired cognitive function in elderly people.Declining cognitive function and cerebrovascular disease are both common in old people. The results of this study tend to support the view that a considerable proportion of cognitive decline in the elderly population is vascular in origin. They also suggest that a high vitamin C intake, perhaps by an antiatherogenic mechanism, protects against both cognitive impairment and cerebrovascular disease. This may have important implications for prevention.

Low blood pressure is reported in Down's syndrome (DS). To assess this and determine whether low pressure results from the disease or from long-term residence in hospital, we measured blood pressure with a random-zero sphygmomanometer in three groups of patients: 52 DS inpatients, 62 DS outpatients, and 60 outpatients with other forms of mental handicap. Relative to normal reference populations, blood pressure was low in both DS inpatients (systolic, score -33 mm Hg, P < .0001) and DS outpatients (-25 mm Hg, P < .0001). It was normal in non-DS outpatients (-4.0 mm Hg, P = .3). Blood pressure rose normally with age in the non-DS group but not in the DS group. We conclude that blood pressure is low in DS and that this is a feature of the disease rather than of the protected environment in which patients live. A mechanism related to trisomy 21 is likely, and there may be a link with Alzheimer's disease (AD) because blood pressure is also low in Alzheimer's and a high proportion of Ds patients develop this disease. If, as is likely, blood pressure is lowered in Alzheimer's by the neuropathy, the same neuropathy developing early in DS may also reduce blood pressure.

Ireland has the fourth highest prevalence of asthma globally, with over 470,000 people with an asthma diagnosis. 1 In general, asthma symptoms can be controlled with inhaled corticosteroids, with the addition of a long-acting β 2 -agonist as indicated, alongside other agents including long-acting anti-muscarinic agents and anti-leukotrienes. 2 The GINA 2021 Guidelines state that many cases of difficult-to-treat-asthma are partly secondary to modifiable factors such as incorrect inhaler technique. An important distinction is that in severe refractory asthma, a subset of difficult-to-treat-asthma, despite adherence to maximized optimal therapies and the treatment of contributory factors, asthma remains uncontrolled. 3 In this subset of patients, symptoms remain inadequately controlled despite maximum conventional therapy and adherence, with 3-10% considered to have severe refractory disease. 4 A number of biological agents targeting the components of type 2 inflammation have been transformative in the management of severe refractory asthma. 5 Omalizumab, the first such agent to be approved for use in severe allergic asthma, is a humanized anti-immunoglobulin E (IgE) antibody. 2 In Ireland, omalizumab is not reimbursed by national bodies but paid for directly by individual hospital budgets, potentially limiting access for patients.Anti-interleukin-5 (IL-5) therapies were first approved for use in Ireland in 2018 and there are currently three agents available for treating adults with severe eosinophilic asthma that is inadequately controlled despite maximum conventional therapy. Mepolizumab and reslizumab target IL-5, 4 whereas benralizumab is an anti-eosinophil monoclonal antibody that binds to the alpha subunit of the IL-5 receptor. 6 Irish guidelines state that patients may be eligible for anti-IL-5 therapy if they have a confirmed diagnosis of severe refractory eosinophilic asthma by a respiratory physician, they have been fully adherent to maintenance therapy, the blood eosinophil count is elevated, and they have had two or more exacerbations in the previous 12 months requiring systemic corticosteroids. 7,8 We performed a retrospective, observational, single-centre review of clinical outcomes in patients switched from omalizumab to an anti-IL-5 therapy in a regional specialist asthma centre in Cork University Hospital, Ireland. This study was approved by the Clinical Research Ethics Committee, University College Cork. Informed consent was obtained from each of the included patients. The study complied with the Declaration of Helsinki. Clinical outcomes in severe eosinophilic asthmatics who remained suboptimally controlled despite omalizumab and were therefore switched to an anti-IL-5 therapy were assessed. Suboptimal control was defined as inadequate control of a patient's asthma and/or multiple exacerbations despite omalizumab.All patients ≥18 years old who switched therapy in our centre from 2018 to 2020 were included. The parameters assessed included the Asthma Control Questionnaire (ACQ) score, annual commun...