Asthma in people over 65

It is estimated that around 6-10% of older people have asthma, and it may genuinely present as a new illness, or the person may have had it for many years.

Because the diagnosis and treatment of asthma in the elderly can be more complicated than in those who are younger, asthma tends to be under-diagnosed and under-treated and indeed may present late, with worse asthma symptoms, as older people may not perceive the feeling of breathlessness so well, and may just believe breathlessness is a normal consequence of ageing.

The elderly asthmatic is more likely to have worse symptoms, more likely to be hospitalised, and more likely to die, because of late presentation, diagnosis, and treatment, and potential interactions of asthma medications with other drugs.

The presentation may not be typical [e.g. of breathlessness at night (paroxysmal nocturnal dyspnoea) rather than wheeze], and though the elderly asthmatic is less likely to have associated allergies and eczema, he/ she is likely to have co-existing conditions, including cardiac conditions, which can confuse the picture.

The very medications, which are normally used to treat asthma can have serious side effects which can worsen the elderly asthmatic’s general condition and quality of life. They are more likely to suffer from a racing heart, tremor and even angina from beta agonists (such as Salbutamol). Theophylline takes a long time to clear from the blood.

Because the elderly asthmatic is likely to be taking other medications for other conditions, there is more likelihood of drug interactions, and treatment goals may have to be modified, because of this, as well as the person’s general condition, and older people are more likely to be taking beta blockers or non-steroidal anti-inflammatory medication, which can make asthma worse.

Adverse side effects can occur when elderly people are put on steroids, as they may become confused or even psychotic, and further osteoporosis may occur in already weak bones.

Older people are more likely to have problems with using metered- dose inhalers, if they have physical impairments [e.g. stroke, arthritis, visual impairments, tremor, or problems with co-ordination]; or mental impairment [such as cognitive impairment]. In these cases, a device to aid metered- dose delivery, a spacer device, or breath-actuated device may be needed.