Asthma in adults and older people
Asthma is a chronic inflammatory disease of the airways, characterized by airway obstruction and increased airway responsiveness to different stimuli. The obstruction is reversible, either spontaneously or in response to treatment. The increase in airway responsiveness may be evident with specific stimuli like cat antigens, ragweed, or dust mites, or with non-specific stimuli like irritants, smoke, odors, infections, methacholine and histamine. While asthma is most commonly thought of as a "childhood disease," it is often diagnosed as a new condition in older people. Whether it begins with a
nighttime cough or difficulty breathing, asthma can be a very frightening disease. As patients age, their lung functioning becomes weaker. Starting from the age of 18 years, every year FEV decreases by about 30 milliliters. It has been postulated that with aging, the functioning of sympathetic and parasympathetic nervous systems in the lungs alters, thus interfering with bronchodilation and bronchoconstriction. However, bronchial response to methacholine, histamine, and anticholinergics does not change with age. This makes methacholine and anticholinergics useful drugs for management. Aging leads to a decreased response to inhaled ß-agonists. To bronchodilate, we may have to use a higher dose of ß-agonists for longer periods.
Prevalence of asthma among the elderly resembles the prevalence in the general population, at 5-7 percent. Many of them develop asthma symptoms for the first time at the age of 60 or 70 years, while there are others who age with asthma. Many seniors diagnosed with asthma have other health conditions to take into consideration, including drug interaction and disease interaction. 20% of the elderly population suffers from asthma. 30% of this group suffers from late onset asthma. Loss of elastic recoil of the airways, decrease in the lung function, associated chronic problems and resistance to drugs may complicate the problem in the elderly. Asthma in the elderly is often overlooked because of many factors. There is a misconception that asthma is a disease of childhood. Clinicians might overlook asthma because the typical symptoms are not distinctive in the elderly. These may be attributed to congestive heart failure (CHF), bronchitis or ischemic heart disease (IHD). Many elderly persons have a reduced perception of bronchospasm. So, they do not go to physicians with complaints of chest spasm. When you add to all this, the fact that in some of them a trial of ß2 - agonists may fail, it opens possibilities to missing bronchial asthma among the elderly.
Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases. Different asthma triggers are more common among seniors than younger people. For example, respiratory tract infections are a major precipitating factor of asthma in the elderly. And these infections can be more persistent and resistant to treatment in older patients. The reasons are still being studied, but researchers suspect that a weaker immune system and prior lung damage may play a role in these differences.
Gastroesophageal reflux disease (GERD) or that heartburn that comes after eating a big meal before bed can provoke asthma. Wearing a scarf over your face can help the asthma that comes from exposure to cold air. Using your inhaled bronchodilator before you exercise can help the asthma produced by exercise. Respiratory infections are a common trigger for asthma. Those slobbery kisses from cute grandchild can be laden with germs. Some of those can't be prevented, but at least you can take a flu shot every fall. Older people are more likely to have other health problems. They have high blood pressure or heart problems. They may take medication for these problems. Sometimes a drug that is good for one health problem is bad for another.
Several medications used more frequently in older people are known to trigger or worsen asthma. For instance, aspirin and other anti-inflammatory medications used to treat arthritis and other pain, beta-blocking agents for hypertension and heart disease, and beta-blocking eye drops used to treat glaucoma are all known to potentially cause or worsen asthma attacks. Symptoms with a new medication might be as subtle as a new cough, or more serious, such as decreased exercise tolerance, wheezing or shortness of breath. Many older people still smoke. Smoking makes asthma and other lung problems worse. Tell your doctor if you smoke or if someone in your household smokes. You may be at high risk for lung problems. Other people in your home may also be at high risk for lung problems.
Asthma in older adults presents some special concerns. For example, the normal effects of aging can make asthma harder to diagnose and treat. So can other health problems that many older adults have (like emphysema or heart disease). Also, older adults are more likely than younger people to have side effects from asthma and non-asthma medicines. You and your doctor must take special care to watch out for these concerns. The best way to do this is by having regular doctor visits. In elderly people as in children asthma assumes peculiar characteristics due to the fact that these subjects have greater "technical" difficulties than others. They often do not know how to correctly test them self for symptoms. They do not know how to to efficiently use Aerosol and medicines. The elderly have a reduced ability to perceive the symptom of air lack.
Moreover old patients for several reasons are often treated with a less aggressive therapy than what's actually needed. Furthermore their illness is often more difficult to cure due to the co-existence of chronic bronchitis (and sometimes, also of other diseases). Some older asthmatics non smokers develop a persistent bronchial clogging even after an aggressive therapeutic participation; It is believed that this can derive from the severely and duration of the disease. It is not rare to observe a meaningful delay in the time with which they demand medical assistance; this is thought to be a significant factor that leads to the death of the patient . Therefore it is indispensable that this category of patients should be treated with the least possible daily treatments and more important clearly explain to them the risks involved with this illness and verify their full understanding about the matter.
A diagnosis of asthma may be missed in an older person because other health problems may mask the disease. In particular, heart disease and emphysema (another respiratory illness that causes breathing problems) are more common in this age group. The symptoms of illnesses such as these can be similar to those of asthma. This is why the signs and symptoms of asthma may not be identified right away. It is also why asthma may go untreated. Another reason why asthma can be hard to spot among older adults has to do with their lifestyles. Older persons are more likely to have inactive lifestyles. Part of the reason for this is because health problems that prevent physical activity are more common with age. One of the ways in which asthma is recognized among younger persons is by the symptoms of wheezing and breathing problems during and after exercise. But if a patient rarely exercises, the opportunity for asthma to produce these symptoms may rarely arise. Asthma symptoms among older adults are more likely to take the form of coughing and producing sputum (fluid) from the lungs. Health care providers are more likely to interpret symptoms like these as being due to other illnesses, such as chronic bronchitis (inflammation of the upper airways) or congestive heart failure (in which the heart has trouble pumping enough blood).
As people age, their lungs become less efficient. Adult onset asthma in a person of middle-age or older can speed up the deterioration of lung functioning. Once lung functioning has deteriorated, it never recovers, so it is important that adult onset asthma be properly managed. This might mean taking preventive medication on a daily basis to protect their lung function at all times. By and large the principles of asthma management in the elderly resemble the principles among the young. Theophylline use can be problematic in asthmatics of all ages. Its metabolism has an uneven decline with aging. It makes it difficult to predict what a patient's body will do with a particular quantity of drug. Moreover, toxicity is riskier at old age and drug interactions are very common. Inhaled medications continue to be the gold standard for care of asthma patients at any age. ß-agonist therapy, though less effective among the older people, is very helpful. Among the older individuals, corticosteroid therapies are very important in management. While caring for the elderly patients with bronchial asthma, one must follow the general principles of geriatric care. Peak flow monitoring should be conducted to help differentiate asthma symptoms from those of other disorders. We need to identify and manage the trigger factors like GERD, occult heart disease, and other medication use.
More information on asthma
What is asthma? - Asthma is a chronic inflammatory respiratory disease characterized by periodic attacks of wheezing, shortness of breath, and a tight feeling in the chest.
What types of asthma are there? - Types of asthma include child-onset asthma, adult-onset asthma, exercise-induced asthma, cough-variant asthma, occupational asthma, nocturnal asthma.
What's bronchial asthma? - Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath.
What is exercise-induced asthma? - Exercise-induced asthma is a form of asthma that some people have during or after physical activity. Exercise-induced asthma is common.
What is adult-onset asthma? - Adult onset asthma generally is the onset of asthma for the first time in someone of middle age or older. Adult-onset asthma develops after age 20.
What is status asthmaticus? - Status asthmaticus is a severe asthma episode that does not respond to standard treatment. Status asthmaticus is caused by severe bronchospasm.
What causes asthma? - Asthma is caused by inhaling an allergen that sets off the chain of biochemical and tissue changes leading to airway inflammation, bronchoconstriction, and wheezing.
What're the asthma triggers? - Many risk factors have been linked to triggering asthma attacks. There are two basic types of asthma triggers, allergic triggers, non-allergic triggers.
Asthma and allergy - Asthma attacks (worsening of asthma symptoms) can be triggered by allergies. Allergy is the leading cause of asthma.
What is an asthma attack? - An asthma attack occurs when the small and medium-sized airways become inflamed and constricted after being exposed to a trigger.
Asthma in children - Asthma is the most common chronic condition of childhood. Asthma symptoms can interfere with many school activities for children.
Asthma and pregnancy - During pregnancy, asthma or asthma episodes will become worse for an estimated one-third of pregnant women, particularly women who have severe asthma.
Asthma in adults and older people - Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases.
What're the complications of asthma? - Uncontrolled asthma in pregnant women puts them at higher risk for complications that can include early labor, hypertension, gestational diabetes.
What are the symptoms of asthma? - The symptoms of asthma include labored breathing, constriction of the chest, coughing and gasping usually brought on by allergies.
What're the warning signs of asthma? - Most people with asthma have warning signs before symptoms appear. There are many warning signs of an asthma episode.
How is asthma diagnosed? - The diagnosis of asthma is made on the basis of typical symptoms and signs. Positive allergy tests support a diagnosis of asthma.
What're the treatments for asthma? - Treatment of asthma is aimed at avoiding known allergens and respiratory irritants and controlling symptoms and airway inflammation through medication.
What quick relief (rescue) medications cure asthma? - Short-acting beta-agonists are the most commonly used asthma rescue medications. Anticholinergics are another class of asthma drugs.
Long-term asthma control medications - Combinations of steroids and other medications are effective for both treating and preventing asthma attacks in patients with moderate to severe asthma.
What're asthma inhalers? - Most asthma drugs are inhaled using special devices or nebulizers. Two common types include dry powder asthma inhalers and metered-dose asthma inhalers.
What're asthma nebulizers? - Asthma nebulizers can be used with all classes of inhaled medications but are most commonly used with short-acting beta2 agonists and ipratropium bromide.
How to control acute asthma attacks? - Acute asthma is an acute exacerbation of wheezing, unresponsive to usually effective therapy and necessitating care in an emergency room or hospital ward.
How to manage chronic asthma symptoms? - The aims of management are to recognize asthma, to abolish symptoms, to restore normal or best possible long term airway function.
What asthma relievers are available? - Asthma reliever is a drug that provides relief from asthma symptoms and is the most commonly used asthma medication.
What asthma preventers are available? - Asthma preventers are to be used twice a day regardless of whether your child has symptoms of asthma.
What's the treatment for childhood asthma? - The goals of asthma therapy are to prevent child from having chronic and troublesome symptoms, to maintain child's lung function.
What's the treatment for asthma in the elderly? - Diagnosis and treatment of asthma can be more complicated in people age 65 and older than in those who are younger.
What can be done to prevent asthma? - Avoiding known allergens and respiratory irritants can reduce asthma symptoms. People with asthma should minimize risk for respiratory tract infections.