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Seniors and Asthma
Distinguishing Asthma From a Heart Condition It is estimated that 6 to 10% of older adults may have asthma. For those who have not been diagnosed, they may not recognize that the symptoms they have are due to asthma. Seniors may have atypical symptoms; a nighttime cough may be their only sign. They may assume their difficulties are due to other factors, such as age, smoking, air pollution or heart trouble. In fact, cardiovascular disorders can coexist along with asthma, which further complicates the diagnosis. It can sometimes be difficult to distinguish one from the other. Episodic wheezing, chest tightness, difficulty breathing and a cough, suggesting a diagnosis of asthma in younger persons, can be manifestations of other disorders in an older patient. These disorders include heart conditions, such as coronary heart disease; angina pectoris; congestive heart failure and primary pulmonary hypertension. Since some of the symptoms of asthma and certain heart conditions can be similar, when making a diagnosis, a physician should pay careful attention to all signs of heart trouble, such as fatigue, an increasing non-productive cough, difficulty breathing, heart palpitations or ankle swelling. Furthermore, if the cough or other breathing problems do not respond to allergy or asthma medication this may be a sign that other conditions should be investigated. Physicians must take great care in interpreting pulmonary function testing in the elderly patient. A diagnosis of asthma can be made when the FEV1 is 80% of the predicted and improves more than 12% after use of inhaled bronchodilator. When evaluating a senior with asthma, it is important to take a detailed look at their environment to detect allergic triggers. The prevalence of allergic asthma in elderly patients has been reported to be lower compared to young asthmatics. However, elderly asthmatics that developed asthma before age 65 have a higher risk of other allergic diseases, with 62% reporting a history of other allergic symptoms, such as atopic dermatitis and allergic rhinitis. The management of asthma in the elderly should follow the guidelines published by the National Institutes of Health (NIH). However, some modifications may be needed due to the physiologic, social and emotional changes associated with aging. Goals of asthma treatment are to maintain the desired level of activity, control chronic symptoms, prevent flares, avoid aggravating other medical conditions, and to avoid adverse effects from the medications. An individualized approach to therapy is important since seniors are more likely to have more than one medical condition. The risk for adverse reactions to medication is greater in elderly asthmatics. When a person has both asthma and a heart condition, medications to control one condition can cause side effects that affect the other. For example, medications taken for heart conditions, such as beta blockers, ACE inhibitors, opiates and COX2 inhibitors, can exacerbate asthma symptoms. On the other hand, beta-agonists, when overused to treat asthma symptoms, can cause myocardial effects, supraventricular tachycardia,or hypokalemia. In addition high dose corticosteroids therapy has been associated with atrial fibrillation which is also more frequently in the elderly. Recently in 2007, it was reported that airway hyperresponsiveness can occur in patients with coronary spastic angina. Asthma in the elderly is frequently overlooked due to a focus on asthma as a childhood disorder. When asthma goes undiagnosed, the symptoms can be frightening and a person's quality of life can deteriorate. It is important for seniors to get an accurate diagnosis, distinguishing asthma from a heart condition, but also recognizing when other conditions also exist. The goal of treatment for asthma is to then restore an independent, active lifestyle, provide education, while preventing side effects from medications and aggravating other medical conditions. Marianne Frieri, MD, PhD, FAAAAI, is a Fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI) and a practicing allergist/immunologist in East Meadow, NY. Copyright 2000, Asthma Magazine. Reprinted by permission. |
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© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
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