Can Asthma Develop In Old Age

Diagnosis And Clinical Assessment: With Special Emphasis On The Clinical Features Of The Overlap Between Copd And Asthma

Asthma is underdiagnosed in the elderly due to misattribution of symptoms and signs to other diseases common in the aged, such as COPD or heart disease, or acceptance of symptoms and limitations as a normal result of aging. Thus, the clinician must remain more vigilant to recognize asthma in older patients .

Aging influences the symptoms of asthma and the risk of mortality. This may be due to changes in airway physiology with aging and the decreased response to treatment .

Life Expectations Lifespan And Maximum Survival

From the perspective of studying aging, there is a significant difference between average and maximum life span. The average life span is the average age reached by members of a given population, and life expectancy is the number of years an individual can expect to live. On the other hand, the maximum life span refers to a measure of the maximum amount of time one or more members of a population has been observed to survive between birth and death .

Over the past decades, with the introduction of modern sanitation, refrigeration and other public health measures including vaccination, antibiotics, and aggressive cardiovascular preventive as well as surgical procedures, there has been an increase in average life span . Early deaths have been diminished and more individuals are reaching old age. In the United States today, life expectancy now approaches 80 years . However, the maximum life span, which is 122 years old, has remained unchanged by the public health initiatives mentioned above .

Although several theories have been proposed, none suffice to account for the complexities of aging. Life span is finite and varies generally from species to species and much less so within species. Variations in maximum life span among different species are often associated with differences in the metabolic rates of oxygen consumption, metabolic potential , and the level of oxidative stress .

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How Can Asthma Symptoms Be Controlled Or Reduced

If your asthma symptoms are caused by allergies, take steps to control known or potential triggers in your environment. Allergy-proof your house for dust, mold, cockroaches and other common indoor allergens to which you are allergic. Reduce your outdoor activities when pollen counts or ozone levels are high. Choose foods that don’t contribute to your asthma or allergy symptoms. Evaluate your workplace for possible allergens and take the necessary steps to reduce your exposure to them.

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What Is The Treatment For Asthma

Asthma symptoms can be treated with a variety of prescription medications that provide quick relief as well as long term control. Lifestyle changes can also reduce symptoms, especially if asthma is triggered by allergies to substances in the environment or to certain foods . Regular vaccinations for influenza and pneumonia are strongly recommended for older adults with asthma.

Keep in mind . . . Short-term use of oral steroids are helpful to treat acute asthma symptoms, or flare ups however, long-term use of oral steroids is usually avoided in older asthma patients. Over time, oral steroids can cause severe side effects, such as weakening of bones, ulcers, or high blood pressure.

People with asthma should develop a written asthma management plan with their physician. An asthma management plan outlines specific treatment and lifestyle practices, including what to do when asthma symptoms flare up or become out of control.

Older asthma patients should be sure to ask their physician about any aspect of their asthma treatment that they do not understand. Keeping the physician informed about how well treatment is working is important. Patients need to tell their physician if they are having trouble remembering to take their medications, or if they are having difficulty using devices such as an inhaler.

Normal Ageing And The Lung

Ageing is associated with a restricted chest wall as thoracic skeletal components become stiffer and less compliant . Age related deterioration and calcification in the rib articulations appear to explain these findings. There is additional evidence that the contractile properties of the diaphragm deteriorate with ageing . In addition, normal aging is associated with a reduction in elastic recoil of the lung due to loss of elastic fibres. In expiration the loss of elastic recoil leads to small airways collapse with associated air trapping and in increase in the residual volume, a normal finding in ageing. There is also a decrease in the vital capacity as a result of a stiffer chest wall and muscle weakness. As a result, the ageing lung is put at a mechanical disadvantage.

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How Is Asthma Diagnosed In Infants And Toddlers

It is hard to diagnose asthma in infants and toddlers. Since they are not able to talk well, they cannot describe how they are feeling. A fussy baby could mean many things. Toddlers and preschoolers are often active, even with chest tightness or trouble breathing.Parents should give the following information to their childs doctor:

• Family history of asthma or allergies
• The childs behavior
• Breathing symptom patterns
• Potential triggers and responses to foods or possible allergy triggers

Lung function tests often used to make a complete asthma diagnosis are hard to do with young children. Instead, the doctor may see how the child responds to medications to improve breathing. The doctor may order blood tests, allergy testing and X-rays to get more information.Using this information, the doctor can make the best diagnosis. Parents may need to take their child to a pediatric allergist or pulmonologist for special testing or treatment.

Management Of Asthma: Pharmacological And Non

Basically, asthma management in the elderly should follow the same rules as for younger patients. The main goals are to achieve asthma control and prevent exacerbations . In these patients, asthma is under-diagnosed and is often confounded with other conditions such as COPD . The evaluation of asthma control/severity may be more difficult. In addition, patients with AIE may be more sensitive to the side-effects of medications . As co-morbid conditions are common in this population, polypharmacy is frequent, thereby increasing the risk of drug interactions. Treatment is often suboptimal, due to underassessment of asthma control/severity by the clinician. Multiple patient factors lead to suboptimal disease control, including misunderstanding of asthma as a disease and the treatment regimen, poor adherence to treatment recommendations, memory problems, and socioeconomic challenges . Regrettably, most asthma RCTs conducted to date have excluded old adults and the elderly, so no evidence on efficacy and safety of respiratory drugs is available. Therefore, most data come from observational studies.

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What Causes Asthma In Infants And Toddlers

We still do not know what causes some people to get asthma. If a child has a family history of asthma or allergies, a specific allergy or had a mother who smoked during pregnancy, they have a higher chance of getting asthma early in life.

A respiratory virus, an illness that occurs in the lungs, is one of the most common causes of asthma symptoms in children 5 years old and younger. Although both adults and children experience respiratory infections, children have more of them. Some preschool children get viral infections often. At least half of children with asthma show some sign of it before the age of 5. Viruses are the most common cause of acute asthma episodes in infants 6 months old or younger.

Coping With An Asthma Attack

Know the danger signs of a serious asthma attack:

• Severe shortness of breath
• Inability to talk well
• Difficulty walking
• Lips or fingernails turning blue

If you experience these danger signs, you are having a major asthma attack. Go to the emergency room or call 911 immediately!

Signs of less severe asthma attacks:

• Coughing, sneezing, itchy throat

When you feel an attack coming, follow these three steps:

• Get away from the trigger that started your attack.
• Take your quick-relief medicine as soon as you notice symptoms and then follow your Asthma Action Plan, which may advise you to take your controller medicine as well.
• If you still have wheezing and shortness of breath, contact your health-care provider or get emergency help.

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How Can I Reduce My Risk Of Getting Pneumonia

There are steps you can take to reduce your risk of getting pneumonia.

Get Vaccinated. Getting vaccinated is crucial to protecting your health. The Centers for Disease Control and Prevention recommends pneumococcal vaccination for adults 65 and older. Medicare covers pneumococcal vaccines for adults 65 and older at no cost. It is recommended that adults 19-64 years old who smoke get vaccinated as well. At your next appointment with your asthma specialist or your primary care physician, ask them about the pneumococcal vaccination. If you are a medical provider, dont miss the opportunity to recommend this vaccination for your patients as appropriate. According to a recent study on pneumococcal pneumonia vaccinations in high-risk adults, on average, had up to five encounters with healthcare providers which did not result in receiving a pneumonia vaccination.

Stay healthy by practicing good health habits. Respiratory infections such as a cold or flu can cause asthma symptoms and flare-ups, and the flu can increase your chances of getting pneumonia. A few ways to prevent getting sick is to:

• Avoid sick people
• Wash your hands with soap and water often
• Clean surfaces that are touched most often such as door knobs, light switches, etc.
• Stay in smokefree spaces. If you smoke, make a plan to quit.

Next Steps

• Talk to your doctor at your next visit to see if the pneumonia vaccine is right for you by asking our Five Top Pneumonia Questions For Your Doctor.

Who Should Treat This Particular Aspect Of Asthma Or Allergies

Many older patients are treated for asthma by their internist or family physician however, if your asthma symptoms are not under control within three to six months, or if you have severe persistent asthma, or if you are having asthma episodes that need emergency treatment, it may be time to see an asthma specialist. Allergists/Immunologists or pulmonologists are specialists who treat asthma. Those who have completed training in those specialties are usually called board-certified or board-eligible.

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The Connection Between Asthma And Osteoporosis

People with asthma tend to be at increased risk for osteoporosis, especially in the spine, for several reasons. First, anti-inflammatory medications, known as glucocorticoids, are commonly prescribed for asthma. When taken by mouth, these medications can decrease calcium absorbed from food, increase calcium lost from the kidneys, decrease bone formation, and increase bone loss. Corticosteroids also interfere with the production of sex hormones in both women and men, which can contribute to bone loss, and they can cause muscle weakness, which can increase the risk of falling and related fractures. Even inhaled forms of corticosteroids can negatively impact bone health.

People with asthma may think that milk and other dairy products trigger asthma attacks, although the evidence shows that this is only likely to be true if they also have a dairy allergy. This unnecessary avoidance of calcium-rich dairy products can be especially damaging for children with asthma who need calcium to build strong bones.

Management Of Asthma In The Elderly

The management of asthma in elderly patients is directed at controlling symptoms and eliminating or reducing exacerbating triggers. Specifically relating to older patients, there are important exacerbating factors including comorbid diseases, appropriate medication usage, drug-drug interactions and drug side-effects, and physiologic differences, that all must be considered to achieve these goals .

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What Are Signs And Symptoms Of Adult Onset Asthma

Regardless of age, asthma symptoms can include:

Dry cough, especially at night or in response to specific triggers

Tightness or pressure in the chest

Wheezing a whistling sound when exhaling

Shortness of breath after exercise or physical exertion

Difficulty breathing

Colds that go to the chest or hang on for 10 days or more

Monitoring Asthma At Home

Some people use a handheld peak flow meter to evaluate their breathing and determine when they need intervention, before their symptoms become severe. People who experience frequent, severe asthma attacks should know how to reach help quickly.

Peak expiratory flow can be measured using a small handheld device called a peak flow meter. This test can be used at home to monitor the severity of asthma. Usually, peak flow rates are lowest between 4 AM and 6 AM and highest at 4 PM. However, more than a 30% difference in rates at these times is considered evidence of moderate to severe asthma. People with moderate to severe asthma, particularly those who need daily treatment to control symptoms, often use a peak flow meter to take measurements and compare them to their personal best to help identify signs of worsening asthma or the onset of an asthma attack.

All people with asthma should have a written treatment action plan that was devised in collaboration with their doctor. Such a plan allows them to take control of their own treatment and has been shown to decrease the number of times people need to seek care for asthma in the emergency department.

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Are There Any Special Considerations For Adults Who Develop Asthma

People with multiple medical conditions need to be aware of how their illnesses and the medications they use may affect one another.

If you take more than one medication, talk with your physician about ways to simplify your medication program. Explore the possibility of combining medications or using alternate ones that will have the same desired effect. Be sure to discuss potential drug interactions with anything you take including vitamins or herbal supplements.

Diagnosing Asthma In Older People

Older people are more likely to have other lung diseases that also cause shortness of breath , so doctors have to determine how much of the person’s breathing difficulty is related to asthma and reversible with the appropriate anti-asthma therapy. Often, in these people diagnosis involves a brief trial of drugs that are used to treat asthma to see whether the person’s condition improves.

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Age Related Changes In Adaptive Immunity

Changes of lymphocyte function with age

The mechanisms of aged lymphocyte dysfunction

Altered expression of chemokines and cytokines via actual production as well as receptor expression are found in both human T cells and murine models of aging. Immunosenescence and clonal energy is also a significant contributor to reduction T cell activity in aging individuals. These senescent T cells escape apoptosis but are unable to be activated with this normal and standard means of activation and may identify both T and B cell compartments of clonal cells that are non responsive and are of very little use in the terms of host defense and/or maintenance of vigilance against disease .

Implications for disease and physiological responses

Asthma Symptoms Can Mimic Other Illnesses Or Diseases Especially In Older Adults For Example:

• Hiatal hernia, stomach problems, heart failure, or rheumatic arthritis can create asthma-like symptoms.
• Chronic obstructive pulmonary disease has many of the same symptoms as asthma. COPD, which includes emphysema and chronic bronchitis, is very common in older adults especially those who are or have been smokers.

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Are There Any Special Considerations For Adults With Asthma

Many adults take several medications and/or use over-the counter medications, such as ibuprofen or aspirin, regularly. Work with your doctor to simplify your medication program as much as possible. Explore the possibility of combining medications or using alternate ones that will have the same desired effect. Be sure to discuss potential drug interactions with anything you take, including vitamins. Some asthma medications increase heart rate. If you have a heart condition, discuss those side affects with your health care provider. Older “first generation” antihistamines can cause men with enlarged prostates to retain urine. Oral steroids can make symptoms of glaucoma, cataracts and osteoporosis worse. Adults with arthritis may need special inhalers that are easier to operate. Anyone with asthma should consider getting an annual flu shot. Older adults also should talk with their doctor about getting a pneumonia vaccination. People with multiple medical conditions need to be aware of how their illnesses may affect one another.

This article was published by AAFA, copyright 1995. It can be accessed online at the following link.

How Does Adult Onset Asthma Compare With Childhood Asthma

Unlike children who often experience intermittent asthma symptoms in response to allergy triggers or respiratory infections, adults with newly diagnosed asthma generally have persistent symptoms. Daily medications may be required to keep asthma under control. After middle age, most adults experience a decrease in their lung capacity. These changes in lung function may lead some physicians to overlook asthma as a possible diagnosis. Untreated asthma can contribute to even greater loss of lung function!

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Cellular Biology Of The Aging Lung

The physiologic and histopathologic findings in the airways of aging subjects are driven by important cellular age-associated changes. Acknowledging the importance of aging and lung disease, the American Thoracic Society highlighted this topic at the 2014 annual meeting. The summary statement recommended to address several of the following tentative hallmarks of mammalian aging: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication when studying lung disease in older patients. At present, most work investigating these cellular hallmarks of aging in the lung has focused on COPD and pulmonary fibrosis. However, a reduced telomere length in peripheral blood mononuclear cells correlated with increased asthma severity in a small group of patients and in another study, was more likely detected in patients with childhood-onset persistent vs adolescent-onset asthma. Additionally, in a murine model of asthma, inhibiting thymic stromal lymphopoietin decreased cellular senscence. Additional future work is needed to more fully address the impact of cellular senescence with asthma.