Chapter 20

Asthma and the Elderly

In This Chapter

Seeking an accurate diagnosis of your condition

Avoiding adverse drug interactions and side effects

P eople are living longer than ever before, especially in developed countries, such as the United States, Canada, and most European Union members. However, people’s increased life spans have also been paralleled by an unfortunate rise in the incidence of asthma worldwide among people older than 65.

For seniors, dealing with asthma can present unique challenges due to the following reasons:

Many elderly patients are first diagnosed with asthma only in their later years, after their respiratory symptoms have become increasingly severe and their health, as a result, has deteriorated.

The process of adjusting to life with asthma can be more complex for an older person than for a younger patient, because in many cases, older patients have multiple medical problems.

In many cases, seniors’ asthma management plans are more intricate than those of younger asthmatics, and may require more frequent medication adjustments due to potential adverse interactions with drugs that many older patients take for their other medical conditions, such as heart disease, high blood pressure, or diabetes (see “Watching out for adverse side effects,” later in this chapter).

Recognizing Asthma Later in Life

Asthma once had a reputation as a disease that primarily affected children and young adults. A common misconception about asthma was that it was a “kid’s disease.” However, as I explain throughout the book, your respiratory symptoms may vary widely and may first appear at any age over your lifetime.

In fact, the incidence of asthma among the elderly in the United States is second only to that found in children under 18 (called extrinsic or allergic asthma). Recent studies show that the condition can actually develop later in life, which explains why some doctors use the term late-onset adult asthma (intrinsic or nonallergic asthma) to describe the ailment.

Keep these important facts in mind when dealing with asthma among older asthmatics:

Many elderly patients with late-adult onset asthma aren’t diagnosed until their condition has deteriorated, because they initially assume their respiratory symptoms are due to a greater susceptibility to colds and bronchial infections later in life. Wheezing can also be a symptom of other underlying conditions, such as heart failure or vocal chord dysfunction (VCD).

Allergic conditions that frequently coexist with asthma in younger patients, such as allergic rhinitis (hay fever; see Chapter 7) and atopic dermatitis (eczema; see Chapter 1), aren’t present as often in elderly asthmatics, which can further increase the challenge of correctly diagnosing asthma in seniors.

Late-adult onset asthma affects older women to a greater degree than older men. Studies indicate that hormonal changes during menopause may account for this disparity.

Some seniors are at increased risk for severe, even fatal asthma attacks because they don’t perceive a worsening of their respiratory symptoms, such as shortness of breath or chest constriction, and thus fail to use prescribed short-relief medications or seek medical help in time.

For this reason, making sure elderly asthmatics properly monitor their lung functions with peak-flow meters (see Chapter 4) is vital, in order to accurately and objectively assess their condition. Lung-function tests should be part of any checkups and medical exams that seniors receive.

Taking Asthma Medications When Older

Just in case the previous section seemed to raise some serious concerns, the good news is that many elderly asthmatics show remarkable improvement in their respiratory condition when treated with appropriate asthma medications. The challenge in some cases may be to find the best combination of therapies to achieve the desired result.

Because asthma often coexists with chronic bronchitis in elderly patients, your doctor may prescribe a one-to-two-week trial therapy with oral corti-costeroids to determine the extent of improvement from spirometry (see Chapter 4) before prescribing appropriate and effective long-term asthma medications.

Your asthma management plan may include a mix of short-term and long-term medications. Your doctor may periodically adjust and refine this multiple drug therapy based on how well you respond to the treatment and also on what other medications you’re taking for other medical conditions. And, because many elderly patients take a variety of prescribed medications, make sure you keep an accurate medication record (see Chapter 3) to reduce the risk of potential adverse interactions between certain drugs.

Using more effective delivery devices

As part of your asthma pharmacotherapy (treatment with medications), your physician may prescribe a recently developed breath-activated metered-dose inhaler (MDI) such as Maxair Autohaler as a short-term rescue medication, and possibly a dry-powder inhaler (DPI) such as Advair Diskus as a long-term controller medication (see Chapter 14).

These types of newer inhalation devices are usually easier to operate properly and also deliver medication to the airways more effectively than older, generic MDIs, which some seniors find challenging to use. Incorrectly using an older, generic MDI can lead to ineffective administration of the medication, eventually resulting in poor control and worsening of respiratory symptoms.

Watching out for adverse side effects

Although pharmacotherapy is a vital aspect of effective asthma treatment in nearly all cases, elderly patients need to understand that they can be at an increased risk for potential adverse side effects from asthma medications for the following reasons:

As you age, your response to the use of bronchodilators may change. For this reason, elderly asthma patients may experience increased sensitivities to adverse side effects of beta ₂ -adrenergic medications, including tremors and an increased heart rate. If you have cardiovascular disease, your doctor may consider prescribing a combination inhaler containing a beta ₂ -adrenergic medication (a short-acting bronchodilator) with an anticholinergic (for example, Combivent; see Chapter 16) as an alternative to additional doses of only beta ₂ -adrenergics.

High-dose inhaled corticosteroid use may predispose patients to cataract formation in the eyes and can potentially reduce the bone mineral content in some asthma patients (particularly the elderly) who may have pre-existing osteoporosis and/or a sedentary lifestyle. If this concern pertains to you, your doctor may recommend calcium supplements, vitamin D, and (for women) estrogen-replacement therapy.

And (for men), inform your doctor of any type of past or current prostate condition before taking any anticholinergic medications, such as ipratropium bromide (Atrovent), because these drugs may potentially aggravate a pre-existing prostate problem.

Because they’re more likely to use beta-blockers, elderly patients are potentially at risk for worsening of asthma due to the blocking activity of these drugs, which prevents beta ₂ -adrenergic medications from relieving bronchospasms. In addition, many seniors take aspirin daily to prevent heart problems, and can have idiosyncratic adverse drug interactions to aspirin and also to nonsteroidal anti-inflammatory drugs (NSAIDs) taken to relieve arthritis. For more information on drug sensitivities and adverse drug reactions that can affect your asthma, see Chapter 5.

Some older patients who may have impaired liver functions may require a reduced dose of theophylline in order to prevent accumulation of this drug in the bloodstream, which can lead to potential side effects. In addition, drug interactions that can cause problems with asthma medications in this age group include some commonly prescribed antibiotics (erythromycin) and cimetidine (Tagamet). Always make sure your doctor is aware of any possible liver conditions that may be affecting you, especially if you take theophylline.