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Seniors and Asthma
Getting the medication and dosage right As people age, there is often a significant increase in the number of medications they take for multiple medical problems. It is essential that older patients taking multiple medications have an awareness of what medications they are taking, how they are to take them, and what the potential side effects can be. This is especially true for the senior who has allergies or asthma. Allergies in the form of allergic rhinitis (hayfever), allergic conjunctivitis, pruritus (itching) and urticaria (hives) are a common problem in the elderly population and often require the use of H1 antihistamines. Antihistamines were discovered approximately 50 years ago and are currently divided into two classes: first generation antihistamines and second generation antihistamines. First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in the elderly population such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. Seniors medicated with this class of medications may have a heightened risk of experiencing these side effects, particularly if they are also being treated with certain antidepressant medications. The second generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. As a result, every elderly patient with allergies that require an antihistamine should discuss the use of second generation antihistamines in place of a first generation antihistamine with their physician. Seniors with asthma also have certain challenges when it comes to medication use. Many elderly patients have developed cardiac conditions and hypertension for which a beta-blocker may be prescribed. This medication may make the treatment of asthma very difficult and should be used in asthmatics with extreme caution. For many years prior to the advent of inhaled corticosteroids and long-acting bronchodilators, a very useful and commonly used medication was theophylline. Those individuals who are still on this medication need careful monitoring. Not only are there many medications that have a clinically significant interaction with theophylline, but numerous medical conditions reduce theophylline clearance, hence increasing the side effect potential. Among the numerous side effects in the elderly population see with this drug, the most significant are tremors, disorientation, seizures, diarrhea and numerous cardiac problems. Finally, asthma patients with concomitant arthritis are at a particular disadvantage since many of the asthma medication devices require a certain amount of coordination, manual dexterity and strength. As a result, those with arthritis and asthma may in fact not be receiving the proper dosage necessary to control their asthma. This may result in the treating doctor increasing asthma medication dosages inappropriately. A nebulizer, a device used to deliver aerosolized asthma medications, may alleviate this problem. As can be seen by these few examples, seniors with allergies or asthma must work closely with their doctor to be sure they are getting the most from their medications without having unwanted side effects. John D. Pauls, PhD, MD, FAAAAI, is a Fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI) and a practicing allergist/immunologist at Sharp Rees-Stealy Medical Group in San Diego, CA. |
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© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
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