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Except for some
precautions, goal of asthma treatment in elderly is same as that
in other age group.
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Elderly
asthmatics are usually suffering from few other medical
conditions that may interfere with asthma treatment.
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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.
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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) are to be
avoided.
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It is
important not to misdiagnose asthma as
COPD because asthma
has a different natural history and a better prognosis with
treatment.
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Dyspnea
(breathlessness) in elderly occurs due to many causes that
include congestive heart failure and other forms of chronic
heart and lung diseases.
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Smoking or
exposure to tobacco smoke should be avoided.
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Spirometry:
A consistent pattern of decreasing FEV1 in tests repeated
during the session is suggestive of asthma.
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Depression is
very common in elderly and can decrease their compliance to
treatment. Depression is also one of the most treatable
problems in the elderly.
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Indoor allergens
or
triggers
(dust mite,
molds etc.) may be more important to evaluate than outdoor
allergens; the specific tests will vary by geographic region.
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Diseases that
mimic asthma in elderly are Chronic Obstructive Pulmonary
Disease, Interstitial Lung Disease, Bronchiectasis, Cardiac
Disease (Angina, IHD and Congestive Heart Failure), upper
Airflow Obstruction (Encroaching tumors, vocal cord paralysis,
and thyroid enlargement), Pulmonary Embolism, Bronchogenic
carcinoma, Aspiration, Gastroesophageal Reflux.
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Elderly patients
with asthma can also have chronic, persistent airflow
obstruction with poor bronchodilator responsiveness; a trial
of therapy with corticosteroids may be necessary to establish
that there is reversible airflow obstruction.
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Coexisting
conditions (e.g., respiratory infections, gastroesophageal
reflux) may exacerbate asthma, hinder effective therapy, and
reduce asthma control.
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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).
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Nonselective
beta-adrenergic blocking agents (like Timolol), even
ophthalmic solutions, should not be prescribed for patients
with asthma, because they can produce severe bronchospasm and
perhaps anaphylaxis.
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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.
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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
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Angiotensin-Converting-Enzyme
(ACE) Inhibitors. can produce cough in some patients.
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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.
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Peak flow meter:
The effectiveness of home peak flow monitoring among the
elderly has not been clearly established.
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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.
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Respiratory
infections and medications for other diseases are the most
common asthma triggers.
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Measures to
avoid or control
triggers should be specific to the patient’s
asthma and allergy history.
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Avoidance of
exposure to allergens and tobacco smoke, both active and
passive, is important.
Click the link >How
to control asthma triggers<
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Last edited 08-1-2008 |