Asthma Subgroups: Geriatric Asthma
Let’s discuss geriatric asthma. It’s a newly defined asthma subgroup. It refers to asthma in the elderly or those over the age of 65. It may present in unique ways compared to asthma in the young. It may require its own diagnostic approaches and treatment options. It may even require its own guidelines. So, here’s what to know about this asthma subgroup.1-3
What are some statistics?
Geriatric asthma is not well studied. Still, there is some information we can gather from the few studies that have been completed.
- Asthma affects about 10% of all adults over the age of 65. This means that asthma is as common in the elderly as it is in the young.1-3
- It tends to be more severe than those with asthma under the age of 65.1
- Of adults diagnosed with asthma after the age of 65, 50% were diagnosed with moderate or severe asthma.1
- Of adults diagnosed with asthma after the age of 65, 95% still had “active asthma” five years later.1
- Females over the age of 65 are more likely to have asthma than males. So, asthma in the elderly is more likely to affect men than women.1
- It may be misdiagnosed as COPD or other lung diseases.2
- Two-thirds (69% in one study) of all asthma deaths occur among asthmatics over the age of 65.1,3
- Elderly asthmatics may also require more emergency room visits, more hospitalizations, and have a reduction in the quality of their lives due to their asthma diagnosis.2,3
- Due to hospitalizations, the cost of treating them is nearly double than the cost of treating younger asthmatics.2,3
How does geriatric asthma present itself?
There are three ways geriatric asthma may present itself.
- It was diagnosed in childhood and never went into remission in adulthood. In this presentation it’s usually allergic asthma and is less likely to be severe.2
- It was diagnosed in childhood and DID go into remission in adulthood only to re-assert itself after the age of 65. In this presentation, it’s also most likely to be allergic asthma and is less likely to be severe. Many of these people may not have known, or have forgotten, about having asthma in childhood. So, they may be misdiagnosed as having adult-onset asthma.2
- It first presented itself and was diagnosed after the age of 65. It’s this presentation that is officially a type of adult-onset asthma. Note that adult-onset asthma tends to be more likely to be severe asthma compared with childhood onset.2,3
The third way geriatric asthma can present itself may denote severe asthma in and of itself. However, all of these presentations may result in asthma that is more difficult to diagnose, and more difficult to treat, compared to non-geriatric asthma.
Why do these presentations make asthma more difficult to diagnose and treat?
There are a variety of potential reasons for this.
- People over the age of 65 are more likely to have other diseases (co-morbidities). Controlling asthma may also entail controlling these other diseases.2,3
- They may have disabilities that limit their ability to adhere to asthma treatment regimens. A good example is arthritis which can make it hard to use inhalers.3
- Asthma medicines are studied on younger people and not the elderly. So, the effects of these medicines may be different in the elderly population. They may also require different doses compared to traditional doses. They may also require trials of second-line asthma medicines, such as biologics or COPD medicines, to obtain ideal asthma control.2,3
- Asthma medicines are not studied with co-morbidities. Some of these other diseases may impact the dose such as kidney disease. Some medicines used to treat these other conditions may have an impact on asthma. A good example here is beta blockers, which may trigger asthma. While some medicines used to treat asthma may impact other diseases such as systemic steroids which may adversely affect diabetes.2
- Geriatric asthma may have a hard time performing the tests needed to diagnose asthma. Physicians may lack references for comparing test results in those with age-related chest wall changes.2
- Some geriatrics may not recognize that they are short of breath. They may brush it off to aging or being out of shape. So this can make them less likely to discuss this with their doctors.3
- A fixed income, or lack of money, may limit access to healthcare.
What to make of this?
People are living longer today than ever before. Because of this, physicians are being exposed to new diseases and, in our case, new disease presentations.
Geriatric asthma has only been lightly studied up to this point. However, from the few studies done, researchers have learned quite a bit. They have learned that geriatric asthma tends to be more severe than non-geriatric asthma. It also tends to be more difficult to diagnose and treat. All of this may eventually lead to asthma guidelines specifically aimed at geriatric asthma and to help all asthmatics obtain ideal asthma control.
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