Asthma

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Asthma is common in adults age 65 and older. Around 7.8% of older adults in the United States have asthma.1 That is about the same as the number of people in the general population who have asthma. But asthma is riskier for older adults than younger people because they face unique challenges.

Some older adults with asthma have had it since childhood. Others developed asthma as adults. Older adults with asthma are less likely to have allergies than younger people with asthma.

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What Are Common Asthma Signs and Symptoms in Older Adults?

The signs and symptoms of asthma in older adults are the same as asthma symptoms seen in other age groups.

Common signs and symptoms of asthma in older adults include:

  • Shortness of breath
  • Cough
  • Chest tightness or pain
  • Wheeze (a whistling sound when you breathe)
  • Waking at night due to asthma symptoms
  • A drop in your peak flow meter reading (if you use one)
How Do Doctors Diagnose Asthma in Older Adults?

Many older adults with asthma develop it as an adult. Doctors call this adult-onset asthma or late-onset asthma.

To diagnose asthma in an older adult, a doctor will ask about your medical history and your family history, do a physical exam, and do lung function tests, if possible.

Asthma can be harder to diagnose in older adults because they often have other health issues. Because of this, asthma is underdiagnosed and undertreated in this age group. Changes in aging lungs can also make asthma worse.

Issues that can make asthma harder to diagnose in older adults include:

Some medicines that older adults use can have side effects that can cause asthma-like symptoms or make asthma worse. The following medicines can cause airway tightening (bronchospasm) or worsen asthma:

  • Heart medicines, such as beta blockers, ACE inhibitors, and some diuretics
  • Cholinergic agents that treat glaucoma, Alzheimer’s disease or dementia, and some gut and bladder conditions
  • Aspirin and non-steroidal anti-inflammatories (NSAIDs)
How Do You Treat Asthma in Older Adults?

The treatment for asthma in older adults involves:

  1. Avoid or reduce asthma triggers. To do this, you need to know what triggers your asthma and then take steps to manage those triggers. Triggers can include:

Once you know your triggers, you can control or manage them. (Use AAFA’s Healthier Home Checklist to help you.)

  1. Take asthma medicines as prescribed. You may need to take medicines daily, as needed, or both. This will depend on the severity of your asthma and the type of medicine you take. Some asthma medicines work to control (or prevent) the inflammation (swelling) in your airways. Other asthma medicines work to “relieve the squeeze” in your airways and aim to stop symptoms after they begin. (Learn more about the different types of asthma medicines and how they work.)
  2. Follow an asthma action plan. It is important to know the signs and symptoms of asthma and when to take your medicines. Ask your doctor or health care provider to help you create an asthma action plan. Remember to review this plan with your health care provider to make sure it is effective and up to date.
  3. Take care of your overall health. There are other medical conditions or illnesses that can make your asthma worse. To keep your asthma under control, you need to take care of other parts of your health, too. Examples include allergies and acid reflux. Doctors will also consider other health conditions and medicines you may have.
What Are the Challenges of Asthma in Older Adults?

Older adults have more asthma symptoms and deaths than younger people.2,3,4 They are also less likely to get the proper diagnosis and treatment they need. They also face socioeconomic issues that may affect their asthma management.

Older adults may struggle with using asthma inhalers due to arthritis or not being able to breathe in well enough to get the medicine from the inhalers. Your doctor may prescribe a nebulizer, a breathing machine that turns asthma medicine into a mist that you can easily breathe in. The nebulizer may be easier to use.

A doctor should prescribe a nebulizer and the liquid medicine that goes into it. If prescribed, your insurance company may cover the cost. You can also buy a nebulizer from a pharmacy or durable medical equipment (DME) company. Nebulizers bought online without a prescription may not meet the standards required by the Food and Drug Administration (FDA). Talk with your doctor about which nebulizer is best for you.

Challenges older adults face when managing asthma:

  • Changes in aging lungs
  • Reduced mental and motor skills
  • Fears and confusion about treatment
  • Costs of medicine
  • Limited income
  • Managing other chronic health conditions
  • Not included in clinical trials (treatments may not work as well for this age group)

Greater asthma disparities exist in older age groups. The impact of asthma is even greater among Black, Hispanic, and low-income adults age 65 and older. Black and Hispanic older adults go to the emergency room for asthma more than 1.5 times than older white adults.5 They also are more likely to have gaps in health insurance coverage.

Black and Hispanic older adults go to the emergency room for asthma more than 1.5 times than older white adults.

Medical Review: June 2022 by John James, MD

References

1. Centers for Disease Control and Prevention. (2019). Most Recent National Asthma Data. U.S. Department of Health and Human Services. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

2. Boulet, L.-P. (2016). Asthma in the Elderly Patient. Asthma Research and Practice, 2(1). https://doi.org/10.1186/s40733-015-0015-1

3. Hanania, N. A., King, M. J., Braman, S. S., Saltoun, C., Wise, R. A., Enright, P., Falsey, A. R., Mathur, S. K., Ramsdell, J. W., Rogers, L., Stempel, D. A., Lima, J. J., Fish, J. E., Wilson, S. R., Boyd, C., Patel, K. V., Irvin, C. G., Yawn, B. P., Halm, E. A., … Ledford, D. K. (2011). Asthma in the Elderly: Current Understanding and Future Research Needs—a Report of a National Institute on Aging (NIA) Workshop. The Journal of Allergy and Clinical Immunology, 128(3), S4–S24. https://doi.org/10.1016/j.jaci.2011.06.048

4. Dunn, R. M., Busse, P. J., & Wechsler, M. E. (2018). Asthma in the elderly and late-onset adult asthma. Allergy, 73(2), 284–294. https://doi.org/10.1111/all.13258

5. National Minority Quality Forum. (2019). National Minority Quality Forum asthma index. SHC Holdings LLC. Retrieved August 4, 2020 from https://index.nmqf.us/index