Q&A on how many elderly people with asthma aren’t diagnosed

If asthma goes undetected, is it dangerous?
Yes. Some people who aren’t given a diagnosis of asthma are poor perceivers of their symptoms, so their airways become narrower and narrower over just a few hours and sometimes maybe just a day. They can have an asthma attack that comes on very rapidly and end up in the emergency room or worse. But as much a problem as not taking action yourself is if a physician hasn’t given you the appropriate medications. Many people just buy Primatene mist because of the difficulty of getting in to see a doctor or because the medications they receive they don’t perceive as being as effective. This Primatene mist has epinephrine or adrenaline in it, it hits their heart and, especially for elderly people that also have heart disease might have arrhythmias, it can be very dangerous and could even precipitate a heart attack. Getting the appropriate medications, that is the anti-inflammatory medication inhalers, is what they need. The increase in asthma death rates has occurred both in children, middle age and in the older populations probably because of the inappropriate medications being used.

What percentage of the elderly do you think has asthma?
We surveyed 5,000 people over the age of 65 in four communities in the United States from social security and Medicare records, so it’s a good sample of the population, and found that 4 percent had been told that they had asthma and they had recent symptoms at least with in the last year. Then another 4 percent on top of that had symptoms that were virtually the same as those who had received the diagnosis of asthma but no physician had ever told them that they had asthma. So there’s probably between 6 percent to 8 percent of people over age 65 in the United States who have asthma.

Does treatment differ for elderly patients than for younger patients?
You actually have to be more careful in the medications that are used for asthma in the elderly. The type of medication is not different but the side effects of medications can be much more severe and more common in the elderly because they also have heart disease, they often have heartburn. They often have what we call comorbidity (two or more conditions at the same time).

Do treatment options differ for elderly patients than younger patients?
The options are virtually the same and the type of medication that should be used is the same. Number one, they inhale cortical steroids and number two take a sympathomimetic (adrenergic) agent such as Albuterol, which is what all asthmatics take when their asthma is not under good control and they need immediate relief from symptoms. It’s even more important in the elderly, however, to use step up and step down therapy — that means to tailor the amount of inhaled steroid and the use of the inhaled bronchodilators to their symptoms and how well their asthma is controlled. Older people have much more comorbidity, that is many of them have heartburn that some asthma medications can worsen. They certainly have thin bones, osteoporosis that prednisone can make worse, and many of them have heart disease that inhaled bronchodilators can sometimes worsen. So we have to be much worried about the side effects. The worst possible thing they can do is use Primatene mist or adrenaline that they can get over the counter in a pharmacy, because that hits their heart very hard.

Are these dangers different for an elderly patient with asthma?
The dangers are similar to that in young people and that is that an asthma attack will become overwhelming very quickly and will basically shut down their airways before they can get to an emergency room and seek help. Therefore, control of the asthma — that is using the preventative medications, inhaled steroids — is much more important in the elderly to prevent that uncontrolled asthma attack from occurring. Practicing prevention rather than just treating symptoms when they occur is more important.

What can happen to an elderly person with poorly managed asthma?
The most common things to happen is that the quality of their life will be reduced. They won’t be able to do the things they would like to do. They won’t be able to go for a walk in the park because they’re worried that the pollens will cause them to have wheezing and shortness of breath. They won’t be able to go outside for instance to go ice skating or in the snow because that cold air will precipitate shortness of breath and wheezing. They won’t be able to engage in many activities that they would like to and they’ll be kept up at night with shortness of breath. Because that’s when asthma always occurs when it’s poorly controlled is late at night, early in the morning so that they’ll be sleepy during the daytime. Basically the quality of their life is what’s going to suffer the most. It’s rare that people die from asthma, but of course there are risks of dying from asthma and those are increased if it’s not well controlled with the very effective medications that we have today.

Source: Ivanhoe News

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