Allegry and Asthma Health - Keeping Kids in the Classroom

Asthma, at My Age?

by Helen M. Sorenson, MA, RRT, FAARC

Are you over 65? Do certain activities make you breathe harder or wheeze? Have you been diagnosed with chronic bronchitis or emphysema? Did you know these symptoms might be caused by asthma instead?

Because asthma is the number one cause of school absenteeism, many people presume that only children are affected. But asthma is not just a disease of children. The truth is, about 10% of people with asthma are over 65. This means that if there are 10 million people with asthma, one million of them will be older adults. While a diagnosis of asthma may sound like terrible news, you may be fortunate that your physician has diagnosed you correctly. A study done in 2003 identified 128 asthmatics who were in their 70s. Only about 53% had received the correct diagnosis of asthma. About 19% had an incorrect diagnosis of chronic bronchitis and/or emphysema (known collectively as COPD), and about 27% had never even been diagnosed with a lung condition.

What's good about a diagnosis of asthma? Asthma is called a "reversible disease," which means if you get good treatment, some of the symptoms may go away. Older patients with asthma tend to report symptoms of shortness of breath and wheezing more often, but they are less likely to have an acute asthma attack or nighttime symptoms.

Treating asthma is extremely important. The longer you have asthma without treating it, the less likely it is that the symptoms will go away. One unfortunate fact is that older people with asthma are usually given less aggressive therapy, despite the need for medication. It is also unfortunate that many elderly individuals delay talking to their physician about asthma-like symptoms, and without treatment, asthma will get worse.

Follow the guidelines

National guidelines have been established for treating asthma for the young and old, and they are based on how severe your symptoms are. For persistent asthma (symptoms more than twice a week), patients should be prescribed an anti-inflammatory drug called a corticosteroid. No other drugs are as effective as corticosteroids (also called "controller medications") in improving asthma symptoms.

Other drugs that can be very useful are short-acting bronchodilators that relax the muscles surrounding your airways. They begin to give you relief fairly quickly when you are short of breath. As with all drugs, side-effects can be dangerous, so your physician and/or respiratory therapist will want to monitor your progress carefully. The "Rule of Twos" has become an excellent guide to the use of short-acting bronchodilators (also called beta-agonist drugs or "rescue medications"). Use these drugs no more than two times per week, refill them no more than two times per year, and use them for nighttime symptoms no more than two times per month.

Other drugs that may not be advisable for older adults with asthma are aspirin and non-steroidal anti-inflammatory drugs like ibuprofen, as they may make your asthma worse. If you have congestive heart failure, high blood pressure, angina, or even glaucoma, you may have been prescribed a drug called a beta-blocker that may also worsen your asthma. Set aside time to visit with your physician about what drugs will be best for you, and understand that older adults with asthma do have to see their doctor more often.

While this may all sound like a lot to deal with, the important thing is that you were diagnosed correctly. Instead of wondering why your breathing is more difficult at times, now you know, and you also know something can be done to help you. Just remember this—when you see your doctor again, thank him (or her) for diagnosing you correctly and getting you started on the road to better breathing.

Helen Sorenson is a Registered Respiratory Therapist and American Association for Respiratory Care member from San Antonio, TX, where she serves as associate professor in the respiratory care program at the University of Texas Health Science Center.

Resources

Bellia V, Battaglia S, Catalano F et al. Aging and disability affect misdiagnosis of COPD in elderly asthmatics. Chest 2003;123:1066-1072.

Petty TL and Seebass JS. Pulmonary Disorders of the Elderly; Diagnosis, Prevention and Treatment. 2007; American College of Physicians.