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Patients & Consumers Online Tools Find an Allergist / Immunologist Pollen Counts Diseases 101 Featured Resources » AAAAI Tips Brochures Topic of the Month Research for Patients Drug Guide Allergy & Asthma ADVOCATE Information Request Form Donate Now En Español Just for Kids Seniors Contact Us Search by Condition (A-Z) Request a Speaker Smoke Free Homes Referral Guidelines Other Resources En Español Just for Kids Seniors		Seniors and Asthma Hurdles to Diagnosing and Treating Asthma in Seniors Marianne Frieri, MD, FAAAAI June 2007 Approximately six to 10 percent of older individuals in the United States may have asthma - a chronic inflammatory disorder of the airways characterized by coughing, chest tightness, shortness of breath and wheezing. These symptoms can be provoked by various types of triggers, including allergens, infections and irritating substances in the environment. Unfortunately, asthma in seniors is frequently overlooked due to the widespread perception of asthma as a childhood disorder. Older individuals are able to travel for extended periods of time and should prepare for changes in the new environment with advice from their asthma specialists and medical insurance coverage outside their country Unrecognized Symptoms In seniors, asthma can surface but go unrecognized for several reasons. Older people may assume their symptoms are a result of their age, smoking or air pollution exposure. Difficulties in diagnosis can also result if the patient is confused or has physical disabilities. Sometimes, symptoms of asthma may not be those with which most people are familiar; in some cases a nighttime cough may be the only symptom. In a recent study in 2007 characterizing severe asthma by the NHLBI, it was noted that severe subjects with asthma were older with a longer duration of disease, greater daily symptoms, intense urgent health care utilization, sinusitis and pneumonia. Proper Diagnosis of Asthma There are many factors that can make the diagnosis of asthma in seniors challenging. Asthma in older patients can be difficult to diagnose when there are coexisting conditions due to sinusitis, gastrointestinal reflux, chronic bronchitis, congestive heart failure, and chronic obstructive pulmonary disease (COPD) as well as other cardiovascular and other pulmonary conditions. Older asthmatics could be less responsive to bronchodilation or be under treated with inhaled corticosteroids. Other concerns in the elderly are progression of osteoporosis with long term corticosteroid use, risks of arrhythmias with beta 2 agonists and other drug interactions. Symptoms associated with asthma in younger persons can signify other disorders in an older person. Additionally, allergies play a less clear role in an older asthmatic's condition. While allergic reactions are often responsible for triggering asthma symptoms in younger people, the role of allergic disease in seniors is less consistent. The prevalence of allergic asthma in seniors has been reported to be lower than that in younger asthmatics. To properly diagnose asthma, the physician should take a detailed patient history, including information about the person's environment. This supplies clues about possible allergic triggers as well as exposure to irritating substances which may be playing a role. The physician will conduct in-office pulmonary function testing, which measures airflow in and out of the airways. When interpreting test results, the physician needs to be aware that obstruction in the bronchial tubes with persistent and severe asthma in an older person may not be reversible and therefore could be difficult to differentiate from COPD or other lung conditions. Treatment is Key Treatment of asthma in seniors can differ somewhat from that in younger people. Treatment in older adults may need to be individualized due to the physical, social and emotional changes associated with aging. Also, the greater incidence of coexisting conditions may require additional considerations in older asthmatics. Regular preventative care should be considered even in mild disease. When physicians devise an asthma treatment plan for an older adult, there are several factors that they may need to take into consideration: Goals for lung function may need to be lower since lung function naturally decreases as a person ages Age-related changes in the body can lead to greater adverse medication side-effects and potential for drug interactions Therapy for coexisting conditions can worsen asthma There may be cognitive or physical limitations that make it more difficult for the person to fully participate in his or her treatment plan The goal of treatment in seniors who have asthma is to maintain or restore an independent and active lifestyle. With proper diagnosis and an appropriate treatment plan, asthma can be successfully managed in people of all age groups; including older adults. Older asthmatics should be taught proper inhaler technique to improve delivery of therapy and a written asthma self-management plan by physician extenders. Marianne Frieri, MD, PhD, FAAAAI, is a Fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI) and a practicing allergist/immunologist in East Meadow, NY. Copyright 2000, Asthma Magazine. Reprinted by permission. <back>
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