Coughing and Wheezing? You Could Have Asthma
Although generally considered a childhood disease, asthma is often diagnosed as a new condition in older adults—and it can often be more of a problem for them. Asthma inflames the airways in the lungs, narrowing them and causing a buildup of mucus that restricts airflow. The effects can range from infrequent, minor wheezing, to shortness of breath and coughing. The elderly are more likely to develop respiratory failure as a result of asthma, and data from the Centers for Disease Control and Prevention (CDC) confirm that asthma-related mortality is highest among this age group.
Hard to Diagnose in Seniors Asthma often goes undiagnosed in older adults, says Alex Federman, MD, an associate professor of medicine at Mount Sinai. “A variety of chronic illnesses, many of which are more likely to occur in older adults, can produce symptoms similar to the symptoms of asthma,” Dr. Federman explains. “Heart failure and coronary artery disease, for example, can cause shortness of breath. Acid reflux often causes coughing, including coughing that happens when the person is lying down. In our research, we find that many older adults aren’t sure when their cough or shortness of breath is a result of their asthma or one of their other illnesses.” Pulmonary function testing also can be less accurate in the elderly, due to difficulty performing the tests—but once asthma is diagnosed, it can be controlled with a combination of prevention strategies and medication.
What Can Trigger Asthma? Respiratory infections, such as colds, flu and pneumonia, are a common asthma trigger in older adults, as is gastroesophageal disease (GERD), in which stomach acids leak back up into the esophagus and mouth. Medications also can be a factor—culprits include beta-blockers like atenolol (Tenormin®) and metoprolol (Lopressor®), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil®, Motrin®).
Asthma also may be triggered by airborne allergens (pollen, cigarette smoke), and indoor allergens like animal dander (shed skin flakes from pets), mold, dust mites, and cockroach and mouse droppings. A family history of asthma also makes you more susceptible, as can your weight, according to a recent CDC study. The study (National Center for Health Statistics Data Brief, March) found that 14.6 percent of obese women were diagnosed with asthma, compared with 9.1 percent of overweight women, and 7.9 percent of normal-weight women. Weight didn’t seem to affect asthma prevalence in men.
Breathing Easy Asthma can’t be cured, but it can be treated. Long-term medications are prescribed to control persistent symptoms, and prevent acute asthma attacks. Inhaled corticosteroids are the most commonly used option, and continuously reduce inflammation in the airways. If you still experience asthma symptoms, you also may be prescribed a bronchodilator, which opens up the airways.
Most asthma medications are delivered via inhalers, of which there are two types: a metered dose inhaler (MDI, see box), and a dry powder inhaler, or DPI. “A DPI is generally easier for older adults to use because it doesn’t require the more complex coordination of steps that the MDI does—the medication enters the lungs as soon as the person takes a deep breath,” says Dr. Federman. “If a DPI isn’t an option, the patient should ask their doctor for a spacer, which is a tube that connects to the MDI. The patient pumps the medication into the tube, then takes a deep breath from the tube.” Another option is a nebulizer, which is a machine that turns the liquid form of a drug into a fine mist that is then inhaled through a mouthpiece or facemask. If none of these approaches are working, Dr. Federman says that oral medications called leukotriene inhibitors may be a reasonable alternative to inhaled steroids.
Self-Help Strategies As well as using your controller medications every day, it is vital to avoid asthma triggers. “Cigarette smoke, mold, and cockroaches are among the most important triggers of asthma,” Dr. Federman notes. “The latter two can be particular issues for older adults because they are often isolated and unable to do the housework necessary to prevent these problems from arising in their homes.” There are services available in many communities to help older adults and others take care of asthma triggers like these in their home—try calling your local area agency on aging, or department of health to see if such services are available in your area.
Another vital self-help strategy is to get your annual flu immunization. Many asthma sufferers don’t because they fear it may worsen their condition—however, flu makes you more vulnerable to asthma attacks, and people with asthma are also at greater risk for complications from flu. “The flu vaccine is safe,” Dr. Federman confirms. “You risk your health far more by avoiding it.”
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