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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.1,2,3

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.1,2,3
  • 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.

  1. 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
  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
  3. 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

Presentation #3 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 with non-geriatric asthma. There are a variety of potential reasons for this.

  1. 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
  2. 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
  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
  4. Asthma medicines are not studied with co-morbidities. Some of these other diseases may impact the dose. A good example here is 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. Some medicines used to treat asthma may impact other diseases. A good example here is systemic steroids which may adversely affect diabetes.2
  5. Geriatric asthma may be harder to diagnose. Some 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
  6. 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
  7. 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. All of this is an attempt to help all asthmatics obtain ideal asthma control.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Selma B., et al, “Adult-Onset Asthma: Is it really different?”  European Respiratory Review, 2013, http://err.ersjournals.com/content/22/127/44, accessed 8/4/17
  2. Battaglia, et al, “Asthma in the elderly: A different disease,” Breathe, 2016, March, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818235/, accessed 5/21/19
  3. Gillman, Andrew, Jo A Douglass,” Asthma In The Elderly,” Asia Pacific Allegy, 2012, April, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345322/, accessed 5/21/19

Comments

  • Debbiekayj55
    5 months ago

    Thank you for this article. I was just in the ER with Asthma Exasperation. Severe reaction to breathing treatment. Now I’m scared to use my rescue inhaler. Going to try the ProAir Respiclick delivery system. Have to try something.

    I had the flu in Jan 2018. Type A
    I have had poor control ever since. Dr thinks my lungs are compromised and it may be chronic. As an adult had exercise induced. Not a big deal. Now OMG
    I never had to use a daily inhaled steroid. I have to be aware of my symptoms at all times. This last time my peak flow was in the red.

    My Doctor has been extremely firm about my control.

    I didn’t understand why it was so bad. And your conclusion about morbidity is exactly what I am being told. Either keep control or I may have to be intubated the next time.

    It is difficult to understand or comprehend how you are feeling. No one understands who doesn’t have asthma. And my Boss, his filthy office and my dusty work environment are killing me. But not 65 and I have to have insurance.

    I am printing and giving this to my Dr. Thank you so much for this information.

  • John Bottrell, RRT moderator author
    5 months ago

    Debbiekayj55. Hi. Sorry you had to go through all of that. You are more than welcome to share the article with your doctor. It may lead to an interesting conversation. Do keep us posted on what your doctor says. Also, here’s hoping your new inhaler helps you obtain better control. Thanks for sharing your experience with the community. John. Author/ Site Moderator

  • Debbiekayj55
    3 months ago

    John
    My Dr found the article VERY interesting. It lead to a great conversation. Dr ASSUMED I knew what asthma was. They assumed I had it since childhood. Now they know, I am a newbie. It took a while to discover triggers and eliminate them. Plus I found I not anyone else needed to be in control of my health.

    Now I go to the Dr with my O2 and peak flow numbers. I now take pictures. My pulmonary dr sometimes needs to see how low my numbers can be. Some little child gave me the crud. I felt the changes in my lungs (immediate). Went to urgent care and told them what I NEEDED. Of course my Pulmonologist increased the steroids. And when I called to give my update of symptoms, unfortunately pneumonia, I was able to give the correct data he needed

    Thank you for this site. Being “geriatric” with asthma is difficult to deal with. Your emails and sites are essential

  • KaraOhki
    5 months ago

    Im 66, and have had asthma since I was a toddler. It must be difficult to develop asthma later in life, I can’t imagine it!

    Just a teeny note – I saw a couple of instances where you said “it’s” when you were using the word as a possessive. This should read as “its”. “It’s” is a contraction of “it is”. As a writer, this is a pet peeve!

  • Leon Lebowitz, RRT moderator
    5 months ago

    Hi KaraOhki, and thanks for joining in the conversation here. You’ve had asthma for all your life, based on what you’ve shared, so I would think you are well equipped at this point to maintain good control over this condition for yourself. Are you able to share some of your experience with the community? If so, we would all appreciate that.

    Thanks also for the little grammar lesson. I will be sure to share this with the editors and proofreaders.

    We’re glad to have you as a member of our community.
    Warm regards,
    Leon

  • Leon Lebowitz, RRT moderator
    5 months ago

    Hi KaraOhki – wanted to let you know the editors have made the necessary corrections – we appreciate you letting us know.
    Leon (site moderator)

  • Shellzoo
    6 months ago

    Great article. I wonder if the reduced lung capacity related to aging plays a factor in geriatric asthma often being more severe. Also while I am not over 65, I was diagnosed after age 50. Even though I was familiar with and understood the signs and symptoms of asthma,I never thought I had it. I thought I was short of breath because I was getting out of shape and old. I thought the daily chest tightness was cardiac even though I checked out fine. As you get older, it is easy to think those symptoms are related to aging. I really think your point #6 is spot on. My mother who is in her 80s was wheezing this past winter. I got her checked right away and it was not asthma but heart failure related to a medication. So clearly other conditions can mimic asthma too.

  • John Bottrell, RRT moderator author
    6 months ago

    Yes. Maybe just an annual blood test and you’re done. That would be neat if asthma could be diagnosed by a simple blood test — and other diseases too. That way you know ,and can seek the best treatment. John. Site Moderator.

  • John Bottrell, RRT moderator author
    6 months ago

    Thank you. Glad you enjoyed it. Yes, I think it’s very important for people (maybe people over the age of 40) not to assume symptoms are due to aging or being out of shape. It’s best to see a doctor and get a proper diagnosis — or you may also get the “all clear.” The more I study about lung and heart diseases, the more true I think #6 is. Hope your mother is doing well. John. Site Moderator.

  • Shellzoo
    6 months ago

    Well, in my 20s, I had a provider suspect I might have asthma after I reported a 2 day wheezing episode following a move when I was cleaning some dusty areas of my old home. I shrugged it off, turned down the rescue inhaler that was offered and figured since I felt great otherwise I had no problems. I was young and I felt fit. I suspect each stage of life there could be situations where people assume the symptoms are not serious or not asthma related. Wouldn’t it be nice to have good yearly asthma screening guidelines. I now regret shrugging off my symptoms when I was younger.

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