Sunday, August 9, 2009

Asthma in elderly

Except for some precautions, goal of asthma treatment in elderly is same as that in other age group. The main points to remember and consider in elderly people are discussed below. Elderly asthmatics are usually suffering from few other medical conditions that may interfere with asthma treatment.This includes hypertension, IHD, diabetes mellitus and other are related diseases. Elderly do not respond as well to drug treatment as young people, so drugs must not be overused as they may aggravate other medical conditions like cardiac disease, arthritis etc. Patient should tell his doctor which medicines he/she is taking for which disease. Medicines that may aggravate asthma like aspirin (commonly used in cardiac conditions and arthritis) and beta-blockers (atenolol) are to be avoided. It is important not to misdiagnose asthma as COPD because asthma has a different natural history and a better prognosis with treatment. COPD is mainly a disease of smokers.Read more about COPD. Dyspnea (breathlessness) in elderly occurs due to many causes that include congestive heart failure and other forms of chronic heart and lung diseases. Smoking or exposure to tobacco smoke should be avoided. When doing spirometry in elderly, a consistent pattern of decreasing FEV1 in tests repeated during the session is suggestive of asthma. Depression is very common in elderly and can decrease their compliance to the treatment of asthma. Depression is also one of the most treatable problems in the elderly so should not be ignored. Indoor allergens or triggers (dust mite, molds etc.) may be more important to evaluate than outdoor allergens since most elderly people spend more time in their homes than outside. The specific allergin will vary by geographic region. Allergy testing can identify the offending allergen. Diseases that mimic asthma in elderly are: 1. Chronic Obstructive Pulmonary Disease. 2. Interstitial Lung Disease. 3. Bronchiectasis. 4. Cardiac Disease (Angina, IHD and Congestive Heart Failure). 5. Upper Airflow Obstruction (Encroaching tumors, vocal cord paralysis, and thyroid enlargement). 6. Pulmonary Embolism. 7. Bronchogenic carcinoma. 8. Aspiration. 9. Gastroesophageal Reflux. Elderly patients with asthma can also have chronic, persistent airflow obstruction with poor bronchodilator responsiveness; a trial of therapy with corticosteroids for 15 days or more may be necessary to establish that there is reversible airflow obstruction. Coexisting conditions (e.g., respiratory infections, gastroesophageal reflux) may exacerbate asthma, hinder effective therapy, and reduce asthma control. Some asthma medications (e.g., theophylline, beta-adrenergic bronchodilators) can elicit adverse responses (e.g., cardiac ischemia or arrhythmia, drug toxicity, gastroesophageal reflux) in susceptible patients with coexisting disorders (e.g., ischemic heart disease, congestive heart failure, acute myocardial infarction, gastroesophageal reflux). Nonselective beta-adrenergic blocking agents (like Timolol, atenolol), even in minute quantities as present in ophthalmic solutions, should not be prescribed for patients with asthma, because they can produce severe bronchospasm and perhaps anaphylaxis. System corticosteroids, thiazide diuretics and beta2-agonists may contribute to hypokalemia (decreased potassium in blood) therefore routine monitoring of serum potassium and magnesium for early detection of electrolyte imbalance should be done. Many elderly patients with asthma have concurrent rhinitis or sinusitis for which they take antihistamines (terfenadine and astemizole) which have the potential to produce prolongation of the QTc interval that could lead to ventricular arrhythmias such as Torsade de Pointes Angiotensin-Converting-Enzyme (ACE) Inhibitors. can produce chronic cough in some patients. Review of patient technique in taking medications is also important; not infrequently, a failure to respond adequately to therapy is a result of improper medication/inhaler technique. Peak flow meter: The effectiveness of home peak flow monitoring among the elderly has not been clearly established. Allergy Tests: Allergy skin tests or studies of specific IgE need not be routinely performed because allergens seem to play a less important role for elderly patients than younger patients. Respiratory infections and medications for other diseases are the most common asthma triggers in elderly patients. Measures to avoid or control triggers should be specific to the patient̢۪s asthma and allergy history. Avoidance of exposure to allergens and tobacco smoke, both active and passive, is important as with asthma patients of any age.--Dr. Sakshi Baijal is MD (Gold Medal) in Respiratory Medicine & TB. He has special interest in asthma and respiratory allergies.Asthma symptomsAsthma diagnosisSource:

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