Asthma in Seniors: Often Missed, Often Deadly

Asthma in seniors is all too often undiagnosed and untreated, with serious — even deadly — consequences. Asthma is a chronic lung disease that causes airway passages to become inflamed and narrowed. Symptoms of asthma include recurrent wheezing, chest tightness, shortness of breath, and coughing. While most clinicians and public health agencies are acutely aware of asthma in children, asthma in older adults is not on the radar screen. For instance, click on over to the Centers for Disease Control (CDC) asthma page, and you’ll find a host of information for specific groups – healthcare professionals, kids, parents, public health professionals, and school nurses/teachers. Adults of any age – let alone seniors – are not included in the target groups.

The focus on childhood asthma is understandable: Asthma is a serious childhood disease, affecting almost one out of ten (9.4 percent of) of children in the United States, according to CDC estimates. That percentage may be much higher in emerging countries, where the pace of industrialization has not been matched by pollution control laws. Asthma often limits children’s activities, setting them up for other health problems such as obesity and depression. Asthma attacks in children cause discomfort, hospitalizations, and death.

Yet asthma isn’t just for children anymore. Asthma affects 7.3 percent, or about one out of 15, adults in the United States – many of whom never experienced asthma as a child. About 40 percent of people with asthma experience their first attack at age 40 or older. That’s partly because aging brings an increased risk of asthma. As we age, structural changes occur in the lungs, blood vessels and connective tissue, leading to decreased lung function.

We really don’t know the true burden of asthma on the elderly, suggests Raymond Slavin, M.D., allergist and professor of internal medicine at Saint Louis University School of Medicine. Slavin cites a recent study that showed 39 percent of seniors with asthma received no treatment. Seniors who live with untreated asthma may experience poorer quality of life, frequent hospitalizations, and death: More than half (60 percent) of people who died of asthma in 2008 were 65 years of age or older.

Diagnosing asthma in the elderly can be tricky. Signs and symptoms of asthma include frequent coughing, especially early at night or in the morning; difficulty breathing; feeling short of breath; tightness in the chest, and recurrent wheezing (a whistling sound when breathing). Symptoms usually worsen with exercise or exposure to cold air or allergens. Based on that list, it’s no surprise that if a first asthma attack occurs in a person aged 65 or older, it may be confused with other common diseases of the elderly such as sinusitis, bronchitis, or emphysema. Allergies – also frequently undiagnosed in seniors – are also associated with asthma. Up to 90 percent of people with asthma also experience allergy symptoms such as a stuffy nose.

Likewise, treatment for seniors with asthma may be more difficult than for younger folks. Some of the most effective asthma medications, such as albuterol, may cause increased heart rates. Beta blockers and ACE inhibitors, used to treat illnesses in common in seniors, such as heart attacks, hypertension and congestive heart failure, can cause shortness of breath, wheezing and coughing. Over-the-counter medications such as aspirin and ibuprofen, which many adults take to lessen the risk of stroke and heart attack or to combat arthritis pain, may exacerbate asthma symptoms.

The upshot? It’s time to rethink yet another assumption about aging and health: Difficulty breathing is not a normal part of aging. Seniors who experience shortness of breath, wheezing, coughing, and other breathing problems should be evaluated for asthma. Clinicians need additional training in recognizing asthma in seniors, public health surveillance methods for asthma in seniors need to be enhanced, and pharmaceutical companies need to develop asthma medications appropriate for older adults.

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