Asthma in the Elderly
More than 1 million American adults older than age 65 are diagnosed with asthma. But the number of seniors with this condition is no doubt much higher, since asthma is one of the most underdiagnosed diseases in the United States, especially among the elderly. Among the reasons:
- Misdiagnosis — Identifying asthma in the elderly can be difficult because asthma symptoms can be confused with symptoms of heart or lung diseases. Symptoms of asthma other than wheezing may be misdiagnosed: a chronic cough might be mistaken for bronchitis, or difficulty sleeping due to breathing trouble might be dismissed as insomnia.
- Triggers — 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.
- Medications — 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. Review all of your medications with your health care professionals if you notice these new symptoms.
If you're a senior who experiences any of the following symptoms, it's a good idea to call your doctor to get a professional opinion to confirm or rule out the possibility of asthma:
- Labored breathing triggered by strong odors or chemicals
- Difficulty sleeping due to shortness of breath, wheezing or cough
- Chronic cough with or without secretions, especially at night
- Chest tightness or pain with deep breathing
- Chest tightness or wheezing triggered by postnasal drip
If you are having troubles breathing or chest pain, you should immediately call your physician to make sure you do not need urgent attention.
It is especially important for elderly people with asthma to keep track of their condition after diagnosis.
- Keep a Diary — Tracking your daily routine — and what prompts asthma attacks — is a good way for seniors to learn their specific triggers so future attacks and symptoms can be prevented. Besides medications, common triggers of asthma attacks in the elderly include respiratory illness such as cold or flu and exposure to airborne asthma triggers such as cigarette smoke, dust mites, mildew and animal dander, strong chemicals or odors.
- Watch Where You Exercise — Exercise may trigger asthma in older adults as cold, dry air evaporates moisture from the airway lining during respiration. This can usually be prevented or minimized by exercising in warm, humidified air, such as at a swimming pool.
- Discuss Your Medications — Make a list of all medications you currently take for other conditions and show it to all health care providers at each visit. Don't be afraid to ask how a new medication being prescribed may affect the treatments you are receiving for other conditions.
- Monitor Your Air Flow — A peak flow meter, which measures lung function, can be used to monitor the health of your lungs and even predict future asthmatic events — allowing you to change or increase your medications to maximize their benefit and even prevent or minimize asthma symptoms. Record the best of three peak flow tests every morning and evening before medication and share them with your health-care provider. Part of the management plan you create should include what you should do when your peak flows decrease.
Medication choices and use may require adjustments for the elderly.
- Sympathomimetics — These inhaled medicines open the airways and provide fast relief. They are called bronchodilators. Examples are albuterol (Ventolin, Proventil), levalbuterol (Xopenex), metaproterenol (Alupent), and pirbuterol (Maxair). They can be given by an inhaler or used in a nebulizer. They can speed up the heart rate, so it is best to start with low doses. People with arthritis, tremors or muscle coordination problems may have difficulty using an inhaler. There are also special devices for inhalers for people with severe arthritis.
- Anticholinergics — These medications are given by an inhaler or used in a nebulizer. Examples are ipratropium (Atrovent) or tiotropium (Spiriva). These medicines open the airways and give fast relief. People with arthritis, tremors or muscle coordination problems may have difficulty using an inhaler. In older men, these inhalers increase the risk for a side effect called "urinary retention." This side effect can cause you to be unable to urinate, requiring emergency treatment and use of a catheter to drain the bladder. If you are taking an inhaler from this class and you notice frequent urination or difficulty urinating, discuss these symptoms with your healthcare provider.
- Methylxanthines (Aminophylline, Theophylline) — These are rarely prescribed today, but can improve symptoms if they are carefully used. They can have side effects including nausea, rapid heart rate, headache and seizures, and doctors have to be careful about possible drug interactions.
- Cromolyn and Nedocromil — Often used as a preventive treatment, since it can help minimize or prevent an asthma attack when used prior to exposure to a known allergen or exercise. These are used more in children than in older adults.
- Steroids (inhaled and oral) — Most often used as an inhaled medication and usually recommended when asthma is persistent. Inhaled steroids usually are started in moderate to high doses and tapered to the minimal dose to control symptoms and normalize peak-flow determinations. Oral steroids, such as prednisone, are very effective but should be taken only for brief periods of time. Usually doctors start with a moderate to high dose of steroid and taper over one to two weeks. As the dose is tapered down, inhaled steroids should be started.
- Anti-Leukotriene Drugs — Leukotriene inhibitors work against leukotrienes, a chemical mediator that produces airway constriction and increased mucus production. The anti-leukotriene medications act either to inhibit the production of leukotrienes or to prevent them from binding to cellular receptors.
They are taken orally on a regular basis to prevent asthma attacks, not to relieve an attack in progress. They seem to be particularly effective against aspirin-sensitive asthma.