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Patients & Consumers Online Tools Find an Allergist / Immunologist Pollen Counts Diseases 101 Drug Guide Featured Resources » AAAAI Tips Brochures Topic of the Month New Research Information Request Form Donate Now En Español Just for Kids Seniors Contact Us Search by Condition (A-Z) Request a Speaker Smoke Free Homes Referral Guidelines Other Resources En Español Just for Kids Seniors		Seniors and Asthma Asthma Control for the Mature Adult Clifford W. Bassett, MD, FAAAAI June 2007 Asthma and other respiratory diseases are particularly common in adults over the age of 65 as lung functioning begins to decrease steadily over the age of 40. This age group is the fastest growing segment of the U.S. population. Asthma symptoms may be seen for the first time at 60 to 70 years of age. Asthma symptoms may not be fully reversible with medications in older adults due to the effects of aging and the buildup of excess mucus produced by the lungs, and may be responsible for a persistent cough in some individuals. Recent surveys have concluded that the quality of life is significantly lower in elderly patients with moderate or severe asthma. This, in turn, affects both emotional and physical functioning. A diagnosis of asthma may not be diagnosed in a timely fashion due to other health problems that may mask this disease. Asthma may not be diagnosed in a timely fashion due to other medical conditions that may mask the asthma. The relationship between asthma and allergies The prevalence of allergies does not necessarily decline in mature adults. A study published in a scientific journal indicated that asthma in senior adults and the elderly is associated with higher prevalence of allergic sensitivities to indoor allergens, i.e., dust/dust mites, mold spores, pet dander, feathers, etc. Almost 75% of the asthma patients studied had positive allergy tests to one or more of the above indoor allergens. The most common positive allergy test in the study, performed at Johns Hopkins University, was cat dander. Non allergic triggers may also contribute to nasal and sinus symptoms in the elderly. Symptoms may also be triggered by colds and infections, air pollutants, cigarette smoke, cold air, fumes, scented perfumes as well as various medications. What medications work? Quick reliever type of medicine, such as bronchodilators, attempt to stop and relieve asthma symptoms once started by opening constricted breathing passages. This type of medication may keep an asthma attack from worsening. However, quick reliever medications are not meant to be used to stop episodes on a daily basis. Another category of medications, known as inhaled steroids, which are preventative in nature, are recommended to keep asthma symptoms from starting. They work slowly over days and weeks to reduce swelling in the lung passages. These medications are taken daily even when you breathe and feel well. Mature adults are more likely to have side effects and drug interactions from asthma medications than are younger patients; this may be the result of the greater number of medications that they are likely to be taking. In addition there may be difficulties in using metered dose inhalers properly in the elderly population Many asthma patients use their quick relief medicine too much. Patients who use their quick relief bronchodilators daily to stop asthma attacks may be in danger of worsening their asthma. A physician/asthma specialist must be consulted to provide expert advice and management strategies when this warning sign is present. Ask your doctor for a preventive medication that will help stop the ongoing inflammation in your breathing passages that causes the frequent and persistent asthma symptoms. Patients with a hiatal hernia, or who suffer with heartburn, and patients at risk for cardiac disease, may require a reduced dosage of "reliever medications." Those patients using inhaled steroids or oral corticosteroid medications, a nutritional evaluation should be done to check for adequate calcium and vitamin D intake. Asthma control goals To participate fully in physical activities Do not miss work due to asthma To avoid severe asthma symptoms To sleep through the night To avoid emergency room visits because of asthma To reduce allergy triggers such as, dust, pollens, smoke, etc. Preventing asthma episodes Protect yourself where you sleep if you have allergies by doing the following: Use tight-woven cotton slipcovers over your mattress and pillow, wash blankets in very hot water every week Remove pets and birds if you are allergic to them Make an effort to get rid of roaches When outdoor pollen levels are high keep windows closed and use an air conditioner Don't smoke and avoid being around those who do Pet allergic individuals (i.e. cat) may benefit from a HEPA air purifier in the bedroom Taking control: A checklist for doctor visits See an allergy/asthma specialist for allergy testing so you can avoid allergic triggers Ask the doctor or nurse to write a asthma medication care plan Ask for a demonstration on how to properly use your metered dose inhaler and/or "spacer-holding chamber" for safe and effective administration of your asthma inhalers Ask for a peak flow meter to monitor your asthma every day Request instructions if your asthma symptoms are worsening Ask for advice regarding special senior programs that may be available in your state if you have trouble paying for medications Bring all medications as well as your peak flow meter records to each visit Tell your doctor if you have gone to emergency room since your last visit Re-evaluate your physical exam with your doctor to rule out other problems (heart disease) are a regularly scheduled basis While asthma may not be fully reversible in the senior population, it should be controllable, if you seek the appropriate help and follow the care plan set out for you by your physician. Clifford W. Bassett, MD, is a Fellow of the AAAAI and Vice Chair of the AAAAI Public Education Committee, and is an Assistant Clinical Professor of Medicine at The Long Island College Hospital, Brooklyn, NY and a Clinical Instructor at NYU School of Medicine. <back>
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