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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 suffering with asthma are discussed below.
1. Elderly asthmatics are usually
suffering from few other medical conditions that may interfere
with asthma treatment. This includes hypertension, IHD, diabetes
mellitus and other related diseases.
2. 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.
3. 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.
4. 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.
5. Dyspnea (breathlessness) in
elderly occurs due to many causes that include congestive heart
failure and other forms of chronic heart and lung diseases.
6. Smoking or exposure to tobacco
smoke should be avoided.
7. When doing
spirometry in elderly, a consistent pattern of decreasing
FEV1 in tests repeated during the session is suggestive of
asthma.
8. 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.
9. 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 allergen will vary by
geographic region. Allergy testing can identify the offending
allergen.
10. Diseases that mimic asthma in
elderly are:
a. Chronic Obstructive Pulmonary Disease.
b. Interstitial Lung Disease.
c. Bronchiectasis.
d. Cardiac Disease (Angina, IHD and Congestive Heart Failure).
e. Upper Airflow Obstruction (Encroaching tumors, vocal cord
paralysis, and thyroid enlargement).
f. Pulmonary Embolism.
g. Bronchogenic carcinoma.
h. Aspiration.
i. Gastroesophageal Reflux.
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11. 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.
12. Coexisting conditions (e.g.,
respiratory infections, gastroesophageal reflux) may exacerbate
asthma, hinder effective therapy, and reduce asthma control.
13. 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).
14. 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.
15. 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.
16. 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
17. Angiotensin-Converting-Enzyme
(ACE) Inhibitors. can produce chronic cough in some patients.
18. 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.
19.
Peak
flow meter: The effectiveness of home peak flow monitoring
among the elderly has not been clearly established.
20. 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.
21. Respiratory infections and
medications for other diseases are the most common asthma
triggers in elderly patients.
22. Measures to avoid or control
asthma
triggers should be specific to the patient’s asthma and
allergy history.
23. Avoidance of exposure to allergens
and tobacco smoke, both active and passive, is important as with
asthma patients of any age.
Click the link >How
to control asthma triggers<
Last edited 22-08-2010
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