Asthma in Older Adults

Asthma is a common disease found in people over age 65. Asthma in older adults can cause serious health problems if not treated properly.

If you are an older adult, or if you are the caregiver for an older person, this information will help you better understand asthma and how it should be managed in individuals age 65 and above. Please keep in mind that this information is not meant to take the place of medical advice from your own physician.

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When Eloise retired at age 65, she had a long list of things she wanted to do! But within just a few months, she was overwhelmed by frequent bouts of wheezing, coughing, and difficulty breathing. She recognized the symptoms of asthma because her young grandson had it, too, but she just couldn’t believe it was happening to her at such a late age. A trip to the physician confirmed her self-diagnosis, suggesting her early childhood asthma may have decided to reappear. Eloise postponed her plans for travel until she and the physician could figure out what medications worked for her and what lifestyle changes helped keep her symptoms from flaring up.

 What is asthma?

Asthma is a disease of increased responsiveness or twitchiness of the airways to various stimuli including allergens and irritants that cause obstruction of the airways. Constriction of muscles around the airway and inflammation result in swelling of the lining of the airway and increased secretion of mucous in the airway. This causes difficulty in breathing and cough.

Fast stats . . . The U.S. Department of Health and Human Services Administration on Aging reports that more than two million Americans age 65 and older have asthma. According to the American Academy of Allergy, Asthma and Immunology, the senior age group represents the fastest growing segment in our country and therefore asthma is a disease of significant importance.

How is asthma different in older adults?

Most people with asthma experience their first symptoms at a young age. But asthma can develop for anyone at any age. It is not uncommon for adults in their 70s or 80s to develop asthma symptoms for the first time. When asthma does occur at a later age, the symptoms are much like those experienced by anyone else. The most common causes of an asthma flare up are a respiratory infection or virus, exercise, allergens, and air pollution (an irritant). Allergens and irritants are substances found in our everyday environment. People who have asthma may experience wheezing, cough, shortness of breath, and chest tightness.

Asthma creates a much greater risk for older adults because they are more likely to develop respiratory failure as a result of the asthma, even during mild episodes of symptoms.

Did you know . . . Older patients with mild asthma symptoms can have the same level of breathing difficulty as younger asthma patients experiencing a severe asthma episode?

Unlike asthma in younger persons, asthma in older adults rarely goes into remission. Instead, asthma is more likely to remain a potentially serious, and many times, a disabling disease.

Why is asthma difficult to diagnose in older adults?

A diagnosis of asthma may be missed in an older person because symptoms of other health conditions are similar to asthma symptoms and may mask the specific symptoms. Asthma symptoms among older adults are more likely to take the form of coughing with the production of sputum (the fluid coughed out) from the lungs. Your physician might interpret those symptoms as being due to other illnesses, such as chronic bronchitis or congestive heart failure.  In particular, heart disease and emphysema, much more common in older adults, especially smokers, can mimic asthma symptoms.

Good to know . . . One of the ways in which asthma is recognized among younger people is by the symptoms of wheezing and difficulty breathing following exercise. When older adults become inactive, the opportunity for asthma to present itself lessens. If you experience asthma symptoms — wheezing, shortness of breath, tightness in the chest, chronic cough — with your regular activities such as housework, shopping, gardening, or walking, be sure to talk with your physician as soon as possible.

When the asthma symptoms are not recognized correctly, they may remain untreated, likely worsening and creating very serious health risks.

Who is likely to develop asthma as they grow older?

Patients with asthma during earlier life may have temporary resolution of asthma with return of illness in adulthood (generally; however is 30-40s). Patients may also develop sinus disease in adulthood with later development of asthma. This latter subgroup tends to have very severe disease (again, commonly seen in the 40s and more common in women).

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 (although often quoted, food as the only cause of asthma in the elderly is extremely rare). 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.

Remember . . . Take your asthma management plan with you when you travel, and be sure to update it regularly when you visit your physician. You may wish to take your inhaler to your visit to review technique and/or resolve any questions regarding the device.

Are there special considerations in treating asthma in older adults?

Yes. First of all, treatment of asthma for older adults can be complicated by the fact that so many older people take multiple medications for various health conditions. Some asthma medications can react with those other treatments, causing unpleasant side effects. In addition, other medications may actually worsen asthma symptoms.

Secondly, older patients are more likely than younger patients to have mental confusion or memory problems. This may be the result of normal aging or of an illness, such as Alzheimer’s disease. Whatever the cause, these problems can make it difficult for certain older patients to follow treatment instructions — especially if that person takes medications for a variety of health conditions.

Additionally, many asthma medications come in the form of an L-shaped metered dose inhaler which requires a certain degree of manual coordination and dexterity. Older people are more likely to have difficulty with this type of medication device, and in using it, may not receive the correct dose. Treatment with a dry powder inhaler or oral medications can help older asthma patients avoid problems with use of L-shaped inhalers.

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 (who specialize in the treatment of lung diseases) are specialists who treat asthma. Those who have completed training in those specialties are usually called board-certified or board-eligible.

Does health insurance cover asthma treatment?

Most health insurance plans provide some level of coverage for asthma patients. Check with your insurance carrier for details. Some things you may want to find out might include:

• Do you need a referral to an asthma/allergy care specialist from your internist or family physician?

• Does the insurance carrier offer any patient education or specialized services related to asthma?

• What coverage is offered for pre-existing conditions?

• What medications are not covered by your plan? (There can sometimes be a delay in approving newly released medications. Your physician may know about them, but your insurance may not cover them yet.)

• Is a flu shot covered as part of asthma care? A pneumonia vaccine?

The information provided in this fact sheet should not be a substitute for seeking responsible, professional medical care.

Reprinted with permission from “Asthma and Allergy Answers,” the patient education library developed by the Asthma and Allergy Foundation of America.