Elderly often suffer from asthma more severely for multiple reasons, including misdiagnosis, the inability to receive proper care, and natural weaknesses in an elder’s body.
Whether you are an elderly individual or have a family member that needs help with a breathing problem, understanding the risks involved with asthma and elderly will help you or a loved one find long-lasting relief.
Why is Asthma Among the Elderly So Dangerous?Unfortunately, asthma can be extremely dangerous for elderly patients, and treating asthma for the elderly can be a long process. According to a review of asthma and elderly-related research, asthma patients who are older have higher morbidity and mortality rates, and many of the deaths are directly attributed to asthma.
In fact, a higher rate of asthma-patient deaths are connected to the disease than deaths in younger people. An elderly asthmatic is five-times more likely to die from the disease than a younger asthma patient. Also, mortality rates have improved for asthma victims, but it appears that this improvement has not yet reached the elderly population. It’s also not uncommon for asthma symptoms to be mistaken for other issues, such as COPD.
The authors of the review cite many reasons why mortality may be worse among seniors, but one of the most speculated is under-diagnosis in people with asthma. Essentially, doctors are concerned that elderly asthma patients may not be properly diagnosed, which could be due to the assumption that asthma is a disease for young children. This under-diagnosis could lead to less treatment.
Factors typical among older adults, such as decreased cognition and improper use of medicine, could also be contributors to this fact. It’s possible that the aging body plays a role in the severity of asthma as well.
The prevalence of asthma in older adults may also be higher than we suspect. The article above says that the current prevalence of asthma is somewhere between 4 to 13% in adults over the age of 65. As the age of the population increases, it’s also likely that the amount of people with asthma will go up as well.
Unfortunately, asthma among elderly patients can be difficult to identify, often because the nature of the disease changes slightly when comparing young and old. However, many of the symptoms remain similar. An elderly asthmatic may have wheezing, chest tightness, or shortness of breath. They could also have symptoms that get worse at night or while exercising. Also, if breathing issues occur in the presence of dust or airborne particles, it may be asthma.
Atopic vs. Non-atopicOne of the issues of elderly asthma has to do with atopic vs nonatopic asthma. Most childhood asthma is atopic, or extrinsic asthma. Extrinsic asthma is characterized by symptoms that are brought by an allergic reaction. This is also known as allergic asthma, and it affects over 50% of asthma sufferers.
Nonatopic, or intrinsic asthma, is triggered by factors that are not related to an allergic reaction. It still causes an obstruction of the airways, and many of the symptoms are the same. However, nonatopic may be more likely to be triggered by stress, anxiety, exercise, or cold or dry air. The major difference is that the immune system, which is involved with atopic asthma, is not present in nonatopic asthma. In older adults, this type of asthma is often diagnosed after a patient has an upper respiratory infection.
Risk Factors for Asthma Among EldersSo, are there any risk factors that contribute to obesity?
Is there any indication that certain situations, life choices, or inherited traits make older people more likely to develop asthma?
While there is no way to guarantee you won’t develop asthma and have reduced lung function, there are some situations that can increase your chances of developing the condition.
The first, and likely the most obvious, is smoking. According to a study conducted by researchers in South Korea, smoking may play a role in the development of asthma among elderly patients. The researchers wanted to understand the condition among the elderly. They used both a questionnaire and testing, which was administered to over 2,400 adults, to reach their conclusions. These adults completed the questionnaire and then underwent testing. In the end, active smoking (as opposed to second-hand smoke, or passive smoking) was found to be significantly related to the prevalence of asthma among subjects who were between the ages of 55 and 64.
Another risk factor, and one that may not be so obvious, is obesity. A study of risk factors, from the same Korean institution that was cited before, found a relationship between obesity and asthma in the elderly population, although they admit that “these associations warrant further investigations to identify their potential roles.”
This was a cross-sectional study that included 994 participants who were all older than 65 years of age. Whether or not the person had asthma was determined through a questionnaire, but certain tests were performed to eliminate “asthma-mimicking conditions.” Obesity was then measured using specific calculations, and a conclusion was reached that asthma and obesity may be connected through certain factors.
How to Reduce Asthma Problems Among the Elderly
DiagnosisIf asthma among elderly patients is not properly diagnosed, it can be impossible to treat or reduce the condition. Therefore, any efforts to help an elderly deal with breathing issues should start with a full diagnosis conducted by a doctor.
When diagnosing a patient, the doctor will do their best to not misdiagnose the condition as COPD, which has many similar traits as asthma.
The doctors will look for many symptoms, and they will likely ask about the patient’s breathing conditions, when the patient experiences trouble, and how frequently problems arise. The doctor will try to find out if the patient has frequent difficulty breathing or tightness in the chest. He or she will ask about recurring coughing or times when wheezing is the only symptom. They will also want to know if the patient has asthma-like symptoms that vary through the day. If so, the doctor will need to know about typical times or situations when breathing difficulty starts. If the symptoms appear to worsen at night, while exercising, or in the presence of dust or smoke, it could be a sign of asthma. The patient will also be asked to provide information on his or her family’s history with asthma, as well as other breathing conditions such as allergies, sinusitis, or rhinitis.
The doctor will likely conduct a physical exam, which will search for a hyperextension of the thorax, forced inhalation, nasal secretions, and other issues. It’s important to remember that the absence of asthma symptoms during a doctor’s exam does not necessarily mean that asthma is not present.
To establish a clear diagnosis, the doctor will need to perform a wide variety of tests. One of the tests is an asthma-specific review of medical history and physicals. You’ll likely need information on all the medications the patient is currently taking, and the doctor may ask for information on past medications as well.
The doctor will also perform a test to see if the patient’s airflow is enough for healthy living. Older adults generally have less airflow than younger people, but the doctor will need to find out if airflow is at the normal level for the patient’s specific age group.
Finally, based on the information gathered, the doctor may prescribe specific testing, which will then guide asthma treatments. This can include airway resistance tests, allergy testing, chest X-rays, and lung-volume testing.
Treating Asthma for Elderly PatientsIf the doctor believes asthma is the cause, he or she will then prescribe treatment, which can come in many different forms. However, treating asthma is difficult because aging and asthma can create complications. There are normal changes in the lungs that are associated with aging, and these changes usually magnify asthma symptoms.
Elderly patients may also respond less to certain treatments, and asthma-treatment education for the patient should take into account the possibility of forgetting procedures for medications or the potential loss of coordination, which could make using certain inhalers more difficult.
Patients with asthma also have an increased chance of adverse reactions to medications, so the doctor will be very careful about prescribing certain treatments. For example, many treatments will worsen asthma or create spasms and should be avoided whenever possible.
Management of an Elderly Patient’s AsthmaNo matter the severity or specific treatment plan for the asthma treatments, all patients should have a regular visit scheduled with their doctor to follow through on the care. In many cases, a doctor will give the patient a treatment plan, which is often written out, so that you know how to best manage your asthma. The plan will help treat current symptoms and, hopefully, prevent new symptoms from occurring. In some cases, elderly patients will need assistance with keeping asthma under control, so friends and family may be called upon to help.
However, because of natural aging, desired outcomes may be difficult to achieve. Therefore, it will be important for the doctor to manage expectations and reaching past lung function will be extremely difficult, if not impossible. In many cases, the doctor will give a patient special training and education on using asthma medication. Treatments can be rough for elderly patients, so the doctor will sometimes modify them to maintain quality of life while still treating the condition.
The chances for drug interaction is also a problem when creating a treatment plan for an elderly person with asthma, so asthma medications need to be prescribed with caution. Older patients are likely to be on multiple medications, and many of these medications have nothing to do with asthma.
For example, older patients may be on medications for heart disease, which could interact negatively with asthma treatments. Many treatments will need to be monitored closely because of the chances for complications. Patients with congestive heart failure are particularly vulnerable to complications and their asthma needs to be approached with caution.
When seeking to manage symptoms, it’s extremely important that you avoid external triggers of asthma symptoms. Smoking, for example, can be a major cause of asthma, so the elderly patient should not be subjected to secondhand smoke. If they smoke themselves, every effort should be made to quit.
Education remains a critical component of managing asthma and asthma treatments. It’s important that the doctor assess the needs of the patient and then make clear recommendations to both the patient and their family. To enhance outcomes, you and the doctor should work on mutually-developed goals and try to iron out barriers that may impede progress.
Eventually, the patient will need to go through a follow-up visit. At this time, you’ll need to tell the doctor about changes in symptoms, either good or bad. The doctor will likely ask about changes in symptoms surrounding night or early-morning symptoms, shortness of breath, and coughing. They may also ask about changes your ability to exercise.
For example, the doctor may want to know if you find it easier to walk a mile or climb stairs compared to before treatment. Take note about any medications that have been taken during treatment, including prescribed and over-the-counter meds, as well as specific asthma medications and any increases of changes in drug use.
Through a few tests, the doctor will likely try to find changes in your breathing pattern and lung function when the patient is both active and at rest, and they may look for any airway obstructions. The doctor can also check for signs of poor oxygen consumption or even heart failure, which are related to asthma.
Side Note: Distinguishing Asthma from COPDAs we mentioned earlier, asthma among the elderly can sometimes be mistaken for COPD, or chronic obstructive pulmonary disorder, which can harm lung function. While similar, these two conditions have a few differences that help identify one from the other.
While wheezing is common in asthmatic patients, it is actually less common in COPD. Night coughing is also common for asthma, but this is less common with COPD. Asthma patients also have a tendency for allergic symptoms, but this is not the case with COPD. While smoking is almost always associated with COPD, it’s less common among asthma sufferers.
These symptoms point you in the right direction, but to fully know whether you have asthma or COPD, a professional diagnosis is required.
These are typical symptoms that can be observed at home, but there still leaves plenty of room for overlap. Fortunately, a doctor can perform certain testing, such as a chest X-ray. For asthma patients, chest X-rays are often normal, although it may show hyperinflation. However, a chest x-ray on a person with COPD could show signs of emphysema or chronic bronchitis. This is one of the ways that a doctor may distinguish asthma from COPD.