Asthma in the elderly or seniors

Lung damage from smoking or extensive exposure to inhaled environmental pollutants causes diseases like bronchitis, emphysema, or COPD in the elderly. However, asthma is also a common cause of respiratory symptoms in this age group.

Like asthma, chronic obstructive pulmonary disease (COPD), also responds to anti-inflammatorv drugs. Thus sometimes it becomes difficult to differentiate between asthma and other forms of obstructive lung diseases. However, after a trial of oral glucocorticosteroids if:
•    There is greater than 12 per cent improvement in FEY
•    Greater than 15 per cent improvement in PEF,
•    Improvement in symptoms,
•    There is reduced bronchodilator requirement,

then asthma should be considered as the cause of chronic respiratory symptoms.

The elderly are also susceptible to episodes of wheezing, breathlessness, and cough caused by heart failure. Increase in symptoms with exercise and at night may add to the diagnostic confusion. A careful history and physical examination looking for features of ischaemic heart disease and cardiac dysfunction, along with an ECG and chest X ray may help in diagnosis, but if doubt still persists, a trial of diuretic treatment is helpful. Reduction of symptoms after treatment with diuretics suggests cardiac origin of symptoms. (Diuretics are drugs which increase the excretion of urine. Some important considerations about asthma in the elderly are:

•    A complete checkup is essential to find out if the patient has any other health problem. The other problem could affect or be affected by the asthma. For example, theophylline, a drug used in treatment of asthma can increase blood pressure.

•    Patients with arthritis of fingers should use a spacer device so that they can use a metered dose inhaler easily.

•    Patients taking long-term steroid medicines should have regular checkups especially for:

•    Complete blood counts, blood sugar, and serum potassium o Eyes, for development of cataract or glaucoma o Bones, for development of osteoporosis.

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