Physiology And Making The Diagnosis Of Asthma
Lung function decreases with age due to increased stiffness of the chest wall, reduced respiratory muscle function and an increase in residual volume from loss of elastic recoil. The decline in the elasticity of the airway is considered the major contributor to the increase in fixed airflow obstruction and work of breathing with age. The result is a decrease in FEV1/FVC, such that normal elders have spirometric features suggestive of obstructive lung disease. Thus, the diagnosis of AIE is challenging, and AIE is commonly misdiagnosed as COPD resulting in the under-diagnosis and under-treatment of asthma . Significant, irreversible airflow obstruction in older adults is usually due to COPD, while remodeling or bronchiectasis with segmental fibrosis is more characteristic of older adults with asthma. Patients with COPD often have increased lung volume , reduced diffusion capacity, and emphysematous changes on high resolution tomographic imaging . When these findings are present, patients with persistent dyspnea and reduced FEV1 of less than 60% predicted are more likely to have COPD than AIE .
It has been suggested that, overall, the prevalence of airway hyperresponsiveness increases with age, and there is a positive correlation between age and airway hyperresponsiveness recruited subjects aged>65;yrs .
Reducing The Burden Of Asthma
Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.
There are two main types of inhaler:
- bronchodilators , that open the air passages and relieve symptoms; and
- steroids , that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.
People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.
It can be difficult to coordinate breathing using an inhaler especially for children and during emergency situations. Using a spacer device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end, and a hole for the inhaler in the other. A homemade spacer, made from a 500-ml plastic bottle, can be as effective as a commercially-manufactured inhaler.;
Access to inhalers is a problem in many countries. In 2019, only half of people with asthma had access to a bronchodilator and less than one in five had access to a steroid inhaler in public primary health-care facilities in low-income countries .
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 .
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Having Compromised Airways Is Scary And Can Take A Psychological Toll
JoJo ONeal, 55, of Orlando, Florida, was diagnosed with severe asthma in 2004. She now runs a Lets Kick Asthma support group, where she has an activity called the Straw Challenge: Anyone who doesnt have asthma is asked to take a cocktail straw, hold their nose, and only breathe through the straw for 15 seconds. Most people dont make it through those 15 seconds; they begin to panic, she says. And thats when I tell them, Imagine. At times it may not be that severe, but it can be. The psychological aspects of going through an asthma attack can really mess with your mind.
Who Can Get Asthma
Anyone can develop asthma at any age. People with allergies or people exposed to tobacco smoke and secondhand smoke are more likely to develop asthma.
Statistics show women tend to have asthma more than men, and asthma affects Black Americans more frequently than other races.
When a child develops asthma, healthcare providers call it childhood asthma. If it develops later in life, its adult-onset asthma.
Children do not outgrow asthma. They may have fewer symptoms as they get older, but they could still have an asthma attack. Your childs healthcare provider can help you understand the risks.
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What Are The Dosages Of Treatment
Everyone is different. The correct dose of a preventer inhaler is the lowest dose that prevents symptoms. A doctor may prescribe a high dose of a preventer inhaler at first, to ‘get on top of symptoms’ quickly. When symptoms have gone, the dose may then be reduced by a little every few weeks. The aim is to find the lowest regular dose that keeps symptoms away.
Some people with asthma put up with symptoms. They may think that it is normal still to have some symptoms even when they are on treatment. A common example is a night-time cough which can cause disturbed sleep. But, if this occurs and your symptoms are not fully controlled, tell your doctor or nurse. Symptoms can often be prevented – for example, by adjusting the dose of your preventer inhaler, or by adding in a long-acting bronchodilator.
Flu Vaccines For People With Asthma
- Injectable influenza vaccines are approved for use in people 6 months and older regardless of whether or not they have asthma or other health conditions. Flu shots have a long-established safety record in people with asthma.
- The nasal spray vaccine is an option for use in people 2 through 49 years old who are not pregnant, but people with certain chronic medical conditions should generally not receive LAIV.
- People of any age with asthma might be at increased risk for wheezing after getting the nasal spray flu vaccine and should talk to their health care provider before getting the nasal spray vaccine.
- Children 2 to 4 years old who have asthma or who have had a history of wheezing in the past 12 months should not get the nasal spray vaccine.
There are several flu vaccine options available this season. Your doctor or other health care professional can answer any questions you might have about flu vaccine.
Get pneumococcal vaccines.
- Pneumococcal pneumonia is an example of a serious;flu-related complication;that can cause death.
- People who have heart disease should also be up to date with;pneumococcal vaccination;to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections.
- You can get either Pneumococcal conjugate vaccine or Pneumococcal polysaccharide vaccine when you get a flu vaccine.
- Talk to your health care provider to find out which pneumococcal vaccines are recommended for you.
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What Do The Two Types Have In Common
Exact causes of asthma can be difficult to pinpoint. Allergies and triggers in the environment can cause asthma symptoms and an asthma flare-up, and genetics can also play a role. But the exact reasons why people develop asthma remain unclear.
Childhood asthma and adult-onset asthma share many of the same triggers. For all people with asthma, exposure to one of the following triggers may cause an asthma attack, though different people have different triggers:
Can Asthma Be Cured
Most people with asthma are able to control their condition if they work together with a health care provider and follow their treatment regimen carefully.
People who do not seek medical care or do not follow an appropriate treatment plan are likely to experience worsening of their asthma and deterioration in their ability to function normally.
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How Many People Die From Asthma
- On average, ten Americans die from asthma each day. In 2019, 3,524 people died from asthma. Many of these deaths are avoidable with proper treatment and care.7
- Adults are five times more likely to die from asthma than children.7
- Women are more likely to die from asthma than men, and boys are more likely than girls.7
- Black Americans are nearly three times more likely to die from asthma than white Americans.7
What Action Should You Take If You Or Someone Youre With Is Having An Asthma Attack
Most asthma patients will have an asthma action plan in place, which outlines what to do in such an event. However, if youre not familiar with their plan, or the asthma attack catches you or them off guard, there are a number of practical steps to take to help deal with the situation.
- Phone the medical emergency number of the country youre in, or get someone else to phone for you, and ask for an ambulance
- Remain as calm as you can, as stress can make asthma worse. Be calm and reassuring if youre with someone whos having an attack
- Breathe slowly and deeply, or encourage the person youre with to do so
- Sit upright in a comfortable position and loosen any tight clothing leaning forward slightly may aid breathing during an asthma attack, so try sitting the wrong way round on a chair and lean forward onto its back
- Use your asthma reliever inhaler while you wait for help if there is a spacer to hand, use that to deliver the medication, as a spacer helps the puffs of an inhaler get into the airways more efficiently
- Stay with the person until help arrives and keep monitoring them. If they seem drowsy or exhausted, it could mean their asthma is getting worse.
Be aware that cold air can make asthma symptoms worse, so avoid taking someone having an asthma attack outside.
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Allergen Sensitization In Older Adults
The role of atopy and asthma in older subjects, unlike in children and young adults, is not completely understood. Over 80% of young children with asthma are allergen sensitized, and atopy in this age group increases disease morbidity . Additionally, atopy plays a critical role in the inception of asthma in this age group, in particular during viral infection . However, with increased recognition of asthma in older subjects, our knowledge on the role of IgE sensitization to antigens and subsequent exposure to subjects with asthma in this age group is increasing. It is well established that with increased age, total serum IgE decreases. This has been demonstrated in several cross-sectional studies of randomly selected individuals. For example, the Tucson Epidemiological Study and the National Health and Nutrition Examination Survey reported that IgE peaks by 20;years of age and is lowest after 70;years . However, not all studies have not supported this trend. . Additionally, when looking at the prevalence of allergen-specific IgE, younger populations, including subjects with and without asthma, tend to have a higher prevalence of allergen-specific IgE sensitization than in older groups . This has been reported in several longitudinal studies from cohorts of randomly selected subjects from Tucson , Nottingham , Copenhagen , and in the European Community Respiratory Health Survey .
Asthma: A Surprisingly Silent Disease
Asthma is known for its obvious and noisy symptoms: wheezing, gasping, and coughing. But experts say that the typical impression of asthma is not always correct.
“Asthma can sometimes be a silent disease,” says Bernstein. “People can walk around with very serious asthma, with significant blockages of their airways, and not show any symptoms.”
Windom agrees. “The severity of asthma symptoms really may not reflect the severity of the underlying disease,” he says. Even if you feel fine, your asthma may still be damaging your airways — and you may be closer to a serious attack than you realize.
Even if you do have symptoms, you may not have an accurate impression of how much they affect you.
“There’s no question that people with asthma tend to think they have much better control over their condition than they actually do,” Edelman tells WebMD.
In a 2005 poll of over 4,500 adults with asthma in the U.S. sponsored by the Asthma and Allergy Foundation, 88% said that their condition was “under control.” But experts question their optimistic judgment. About 48% said that their symptoms disturbed their sleep. And 50% said that asthma has made them give up in the middle of a workout. Those are severe symptoms for people who supposedly have their condition “under control.”
While many adults have trouble assessing their own asthma, it’s a special problem for children. They may not remember life without symptoms.
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Most Recent National Asthma Data
These tables feature the latest national and state statistics on the burden of asthma among children and adults. The data are from national and state surveillance systems administered by the Centers for Disease Control and Prevention . Links to sources are provided with each table to assist with finding additional information on the data and relevant tables and reports.
|Characteristic2||Weighted Number with Current Asthma1||Percent|
|Below 100% of the poverty threshold||4,814,158|
|100% to less than 250% of the poverty threshold||7,837,412|
|250% to less than 450% of the poverty threshold||6,345,803|
|450% of poverty threshold or higher||6,138,494||5.9|
Abbreviations: NH = Non-Hispanic, SE = Standard Error1Includes persons who answered “yes” to the questions: “Have you EVER been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”2Numbers within selected characteristics may not sum to total due to rounding and varying missing values.3Poverty level is based on family income and family size using the U.S. Census Bureau’s poverty thresholds. Poverty level was calculated separately using 10 imputed income files.Source: 2019 National Health Interview Survey Data, Table 3-1 and Table 4-1 .
Current Asthma1 Prevalence by Race and Ethnicity
NationalPrevalence of Asthma Attacks1 among People with Current Asthma2 by Age
Prevalence of Asthma Attacks1 among People with Current Asthma2 by Race and Ethnicity
When Living With Asthma Demand The Best Treatment
If you’re suffering from asthma now, understand that you can feel better. Doctors have treatments that will help.
Of course, many things can get in the way of good treatment. One of them is the price. Experts agree that the costs of many asthma medications have become very high in recent years. According to the 2005 Health Costs Survey sponsored by the Kaiser Family Foundation, the Harvard School of Public Health, and USA Today, 43% of all people with asthma said that, in the past year, they could not afford their treatment.
If the price is a problem for you, talk honestly with your doctor. See if you can get some free samples. Ask about assistance programs offered by pharmaceutical companies or by your state.
Whatever you do, don’t put off getting treatment. Delaying might make your asthma worse.
So you need to take charge of your health care and fight for the best treatment you can get. Don’t settle for a life restricted by symptoms. Don’t settle for treatment that isn’t helping.
“Demand that you get aggressive treatment of your asthma,” says Edelman. “There is no reason for you to be suffering. You have the right to feel well.”
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Benefits Of Shared Medical Appointments
A is an exciting and new model of care that increases the amount of time that a provider has with you. The SMA involves meeting with a provider in a comfortable and friendly group setting with other patients who have a similar health condition. This team approach allows us to provide you with a better understanding of how to take care of your health and answer your specific questions. For our asthma patients, it offers help and support to one another by sharing experiences.
Identify And Avoid Your Triggers
It’s important to identify possible asthma triggers by making a note of where you are and what you’re doing when your symptoms get worse.
Some triggers can be hard to avoid, but it may be possible to avoid some, such as dust mites, pet fur and some medicines.
You’ll have regular contact with your doctor or asthma nurse to monitor your condition.
These appointments may involve:
- talking about your symptoms for example, if they’re affecting your normal activities or are getting worse
- a discussion about your medicines including if you think you might be experiencing any side effects and if you need to be reminded how to use your inhaler
- breathing tests
It’s also a good chance to ask any questions you have or raise any other issues you want to discuss.
You may be asked to help monitor your condition between appointments. For example, you may be advised to;check your peak flow if you think your symptoms may be getting worse.
Your personal action plan should say what to do if your symptoms get gradually or suddenly worse. Contact your doctor or asthma nurse if you’re not sure what to do.
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Other Ways To Stay Well In Later Life
Studies have shown that people who keep;exercising;have more chance of staying healthy as they get older.
Even if your mobility isnt as good as it was or you find you get tired easily, there will be an activity you can do.
Keep to a healthy weight
Keeping to a healthy weight can lower your risk of asthma symptoms. Studies show that if youre very overweight, even losing a bit of weight, can make a difference to your asthma.;
It can feel harder to shift the weight as you get older, particularly if youre less active than you were. Find out what support you can get.
If you smoke, youre more at risk from asthma symptoms and attacks, as well as COPD.
Giving up smoking not only lowers your risk, but it also means your medicines will be more effective.
Look after your mental health
If youre worried, down, or lonely, talk to someone about how you feel. Age UK; has an Advice Line: 0800 169 2081.
We all need a support network of friends, family and neighbours, says Dr Andy. Share your asthma action plan, so that anyone caring for you knows what to do if symptoms get worse and who to call for help. And tell your GP or asthma nurse how youre feeling too.
You can talk to a respiratory nurse specialist on our Helpline:;0300 222 5800;. Or you can;WhatsApp them on 07378 606 728
Next review due December 2023