Asthma in Older Adults -- Asthma Is Not Just for Kids
People tend to think of asthma as a kid's disease. But asthma is actually quite common in older adults, people over the age of 65. In fact, the U.S. Department of Health and Human Services Administration on Aging reports that more than two million Americans age 65 and older have asthma. And the CDC says that translates to nearly 7 percent of people age 65 and older.
Some experts believe those numbers are growing rapidly. However, Dr. Sameer Mathur, an associate professor in the Division of Allergy and Immunology at the University of Wisconsin-Madison School of Medicine and Public Health does not believe asthma in older adults is actually becoming more common. Instead, he suggests that an increasing awareness of asthma in our aging population has led to more accurate and more frequent diagnosis.
On the other hand, Dr. Mathur also points out that asthma in our seniors continues to be underdiagnosed and undertreated in many cases. One reason for this is that some asthma symptoms can mimic those of other chronic health issues common in older adults, such as heart disease. Another is that symptoms can be less mild than in younger people (except when flaring), so seniors are less likely to report their symptoms to the doctor.
What's Different About Asthma in Older Adults
Asthma can arise at any age. So, older adults who have asthma may fall into one of these categories:
- People who had asthma as a child and carried it into older age
- Those who had asthma as a child, then went into remission, and asthma symptoms reappeared after age 65
- Those who are newly diagnosed after age 65, with no previous history
Asthma in older adults has similar underlying causes of allergy, with inflamed and irritable airways. The symptoms of wheezing, breathlessness, wheezing and cough are also the same. But asthma after the age of 65 tends to be more severe, as noted:
- Typical aging-associated changes in lung structure are likely to magnify asthma symptoms
- The aging immune system is more susceptible to inflammation and infection
- So, exacerbations occur more often and are more severe
- 10% of seniors with asthma have severe asthma that is poorly controlled
- Asthma is less likely to go into remission
- There is a greater risk of death from asthma in the older population
It's also important to note that complications may arise when the older adult also has other chronic health issues and/or takes other medications that may interact with asthma treatment. And sometimes asthma treatments, such as inhalers, are not used correctly due to aging-related debility or cognitive functioning. Plus, some studies found that older patients also intentionally do not take their asthma medications for a broad range of reasons.
Asthma Diagnosis Is Challenging in Older Adults
As mentioned above, the asthma diagnosis is sometimes missed in seniors because their symptoms may be similar to those of other health conditions. Or, other health problems they already have mask the new asthma symptoms. Also, because coughing that produces mucus or phlegm is typical in asthma in older adults, the physician might interpret those symptoms as being due to chronic bronchitis, COPD or congestive heart failure.
It's important that doctors make the right diagnosis between COPD and asthma, because asthma has a better prognosis and is treated differently. To assess for asthma, the doctor will need to:
- Look for a family history of asthma
- Closely monitor symptoms
- Perform spirometry, a breathing function test to look for airflow obstruction, a hallmark of asthma
Treating Asthma in Older Adults
Asthma is treated in older adults pretty much the same way it is treated in younger patients:
- Controller medicines, to decrease inflammation and prevent symptoms
- Quick-relief (rescue) inhaler, to resolve symptoms as they arise
- Lifestyle changes to reduce exposure to asthma triggers
Oral steroids may also be used on a short-term basis to treat severe asthma flare-ups. Long-term use is generally avoided, however, as the potential side effects from prolonged use can be problematic for the older adult.
However, treating asthma in this age group can be challenging, due to the interplay between the effects of aging on the airways, asthma and other health conditions.
And any new treatment in seniors must be carefully monitored. Asthma medicines can sometimes interact with other medications, causing unpleasant side effects. Plus, some non-asthma medications may worsen asthma symptoms.
Older adults should also have a written Asthma Action Plan in place to help with self-management. If you don't have one, be sure to discuss this with your healthcare team. Be sure to discuss any questions or concerns with your team as well. If you are having trouble using your inhalers or remembering to take your medication, share that with your doctor as well so that you can find solutions together. Regular follow-ups with your healthcare team are also essential.
If your asthma does not come under control with the help of your family doctor within a few months, it may be time to see an asthma specialist. Both allergists and pulmonologists are specialists who treat people with asthma.
Asthma is not just a disease affecting children. Adults of any age can develop asthma too, even after age 65. The course of the disease can vary greatly with age. It can also be more difficult to diagnose as we age. Plus, treatment becomes challenging when there are other health conditions and treatment plans in effect.
The key is for older adults to share any symptoms they are noticing openly with their physicians. And then to work closely with the healthcare team to manage asthma. Although it may be more challenging in older adults to achieve asthma control, it is still entirely possible.
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