Older Adults and Asthma: Why Do Some People "Grow Into" Asthma?
A few years after my own diagnosis of asthma, my grandma also learned she has asthma. Now, asthma potentially has a genetic link, so the fact that from her diagnosis I learned that her father had asthma, this made a bit more sense (on top of my own other personal risk factor storm), for why I also developed asthma.
What, though might cause people to develop asthma at different points in their lives? When I wrote about women and asthma, I looked into the link of hormonal factors associated with development of asthma as well as effects of hormones on asthma flare ups in women. I learned that there is another peak in asthma diagnoses among women over the age of 50 due to hormonal changes—this leads me to wonder: do all older adults have a higher chance of developing asthma as they continue to age?
Older adults—those over 65, in this case—can and do develop asthma. There are also specific concerns with managing and treating asthma in older adults. Two million adults over 65 in the United States live with asthma 1, and it is not uncommon for people to develop asthma symptoms for the first time in their 70s or 80s, or those who had childhood asthma go into a period of “remission” as adults, to redevelop symptoms once they reach older adulthood 1. This is because as we age, we experience a natural decrease in lung function—slowly and steadily after the early to mid-twenties when lung function peaks—this reduction in lung function is greater in men than women, and increases airway inflammation and energy used for breathing, as well as decrease in strength of the muscles around the lungs that assist with breathing 2.
For those who develop asthma later in life, the disease is not much different than it is for those who are younger. Triggers remain the same—allergies, exercise, smoke, chemical irritants, and so on—though even mild symptoms may affect older adults more severely, even developing to the point of respiratory failure even though the same symptoms would not cause this reaction in a younger person. 1 Respiratory viruses (such as colds or the flu) are suggested to account for the bulk of asthma symptoms among adults, while allergies (including nasal and eye symptoms, in addition to breathing problems) typically decrease with aging, although they may persist—the use of the blood test for IgE (immunoglobulin E) remains a reliable indicator of allergy in older adults. 3
While the same medications are prescribed for those who develop asthma later in life, they may be less effective, although they may respond better to leukotriene receptor medications than corticosteroid—the opposite that is usually seen in younger people with asthma.3 In severe exacerbations, older adults are less likely to respond well to bronchodilators, and the reasons for this are not yet known. 3 Older adults may also experience difficulty using certain types of inhalers for different reasons, including ability to forcefully inhale (for dry powder inhalers) or hand dexterity (for pressurized inhalers), or coordination with timing the actuation (puff of medicine) of an pressurized inhaler with the inhalation. 2 In addition to these factors, if memory issues are present, or multiple medications are being taken, these things need to be taken into account when determining a treatment plan for older adults with asthma—strong communication and asthma education are of even greater importance here! 3 Most older adults are able to identify their asthma triggers 2 —exercise, cold air and animal exposure are among the most common triggers identified in the elderly4 , so education on how to manage these triggers is important to prevent decline in quality of life in older adults due to asthma.
While we're not totally sure why some people get asthma later than life, patients, caregivers and physicians alike, it is important to understand the differences that older adults with asthma may experience in how their disease may look, or respond to treatment. It is equally important to not be discouraged by this knowledge, but use it as a tool—it may take doing a variety of lung function and blood tests, or trying different medicines, but the more we know about our asthma, regardless of age, the better equipped we are to share our experiences with our care teams and take the steps needed to feel better.
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