Asthma is a complex disease with multiple triggers. In older patients, who typically have a number of ailments, the diagnosis and management of asthma may be more difficult. Reasons include:
“Masked” Symptoms: Symptoms of asthma may be dismissed as other conditions — a chronic cough mistaken for bronchitis or not sleeping during the night that’s dismissed as insomnia, for instance. Shortness of breath may be subtle and reported only as fatigue.
Asthma Triggers: Conditions that contribute to asthma severity may be missed. Symptoms of allergic rhinitis, sinusitis and acid reflux are few and sometimes silent in the elderly.
Medications: Several medications used more frequently in old age are known to trigger or exacerbate asthma. For instance, aspirin and other anti-inflammatory medications used to treat arthritis and other pain, beta-blocking agents for hypertension and heart disease, and beta-blocking eye drops used to treat glaucoma are all known to cause or worsen asthma attacks. Be sure to keep a list of all medications that are being used and show it to all health care providers at each visit.
Asthma management in the elderly is also more complicated.
Medication Issues:
- Impaired coordination and use of inhalers (especially in patients with arthritis, tremor or stroke). A breath actuated inhaler (such as Maxair Autohaler) may be a better choice for some patients.
- Reduced responsive to some medications (short-acting bronchodilators). Atrovent may serve as an adjunct in addition.
- Greater susceptibility to medication side effects such as steroid-induced osteoporosis.