Do You Have Late-Onset Asthma?
Asthma is typically thought of as a respiratory disease that affects mostly children. Nevertheless, this breathing disorder is often misdiagnosed and undertreated in seniors. It’s estimated that up to 13% of people over age 65 in the United States suffer from asthma. “While most elderly asthma patients have a history of childhood asthma or had symptoms in earlier life, late-onset asthma is not unusual,” says Igor Barjaktarevic, MD, PhD, Medical Director of the COPD program at UCLA Medical Center.
The main reasons why asthma may be overlooked as a diagnosis is the fact that symptoms, such as cough and difficulty breathing, are common and often associated with numerous other medical conditions that older adults are prone to have. “Obesity, cardiovascular disease, gastroesophageal reflux, or allergies and post-nasal drip are frequently seen in this population, leading
to misdiagnosis and inadequate therapeutic approaches,” explains Dr. Barjaktarevic. “In addition, poorer perception of what is a disease versus what is an “expected” age-related decline can contribute to the overall underdiagnosis of asthma in the elderly.”
Compared to younger people, asthma in older years is known to lead to greater possibility of more severe and more life-threatening complications.
What Causes Asthma
Asthma is characterized by airway hyperreactivity and airflow obstruction, but a full understanding of why certain people have a tendency toward developing asthma is still missing. Asthma may run in families, but environmental factors may also play a significant role. Asthma development in the elderly may be related to the deterioration of normal immunological responses as well as to the decrease in elasticity of lungs, greater chest wall rigidity, and worsening respiratory muscle strength.
Spasm, Secretions, Inflammation
Asthma affects the airways in basically three ways. The air tubes in the lungs, called bronchi, have tiny muscle cells that can spasm. When they do, it can feel like trying to breathe through a straw. There are also secretions that can plug up the bronchi, inhibiting oxygen from reaching the airways. And then there’s inflammation,
a lot of it. This causes the bronchi to thicken, and thus the space between them narrows. All this leads to symptoms, which include coughing, wheezing, breathlessness, and chest tightening. In addition, while asthma doesn’t typically cause chest pain, excessive coughing can lead to soreness around the ribcage.
Attacks and Triggers
Asthma attacks may occur in response to specific triggers, such as dust, pollen, mites, mold, and animal dander— all of which can also cause allergies. In fact, asthma and allergies often occur together. Some people may, therefore, find relief with allergy shots that make them less sensitive to triggers.
Other asthma triggers include cold air (especially when exercising in it), viral infections, airborne irritants (e.g., cigarettes, pollution, paints), stress, and even strong emotions can cause an attack. Sometimes a medication may be a culprit. For example betablockers often used to treat high blood
pressure, such as atenolol (Tenormin) and metoprolol (Lopressor), may incite an attack. Some people may also be sensitive to over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve).
Many people with asthma also may have elevated eosinophil levels. These white blood cells are a normal part of the immune system. But when there are too many of them, airways can become inflamed and symptoms can become worse. Asthma can’t be cured or prevented per se, but it may be possible to reduce attacks and prevent asthma from getting worse.
Diagnosis and Treatment
Spirometry is a pulmonary function test that measures how much and how fast air moves upon inhale and exhale with maximum effort. A bronchodilator medication also may be used to evaluate the response of your airways. If results are better, asthma is likely. This is in contrast to chronic obstructive pulmonary disease (COPD), as a bronchodilator will not normalize the air flow in someone with COPD. Most asthma medications are delivered via different types of hand-held inhalers, which can sometimes be challenging to operate and thus lead to suboptimal treatment.
Adequate education, reassessment of response, and adherence to prescribed medications are all important to asthma management. “It may be difficult to prevent asthma, but the goal of health care is to recognize it, manage adequately, and prevent asthma attacks,” says Dr. Barjaktarevic. “Good education, physician follow- up and creation of action plans are crucial for asthma control in the elderly.”
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