Asthma prevalence increases with age, as does the risk of dying from asthma.The National Guidelines for the Diagnosis and Management of Asthma (U.S.) apply to all ages.
However, the elderly patients are very heterogeneous. Their asthma can begin at any time and can vary in severity. It is frequently associated with comorbid lung diseases. Many patients have irreversible airway obstruction, which is due to severe airway remodeling, chronic obstructive pulmonary disease (COPD), or bronchiectasis.
Diagnosis should include chest radiography (CXR) and computed tomographic scanning (CT of the chest) to diagnose other lung diseases if FEV(1) remains low after treatment.
Asthma pathogenesis includes not only IgE-mediated allergy but also innate immune inflammation from endotoxin and trypsin-like proteases, and therefore evaluation and control of environmental exposures is an important part of management.
Elderly patients have reduced response to bronchodilators and increased side effects from beta adrenergic agonists and glucocorticoids.
In addition, many elderly patients have difficulty inhaling aerosols, and therefore nebulizers might be a better delivery system.
Oral medications have the benefit of greater ease of administration and greater efficacy on the peripheral airways. Leukotriene antagonists and low-dose theophylline are often helpful additives to aerosol glucocorticoids.
References:
Asthma in the elderly: Diagnosis and management. Reed CE. J Allergy Clin Immunol. 2010 Jul 29.
Allergy and Asthma in the Elderly, Seminars in Respiratory and Critical Care Medicine and Medscape, 2010. http://goo.gl/UHiq6
Asthma prevalence increases with age, as does the risk of dying from asthma. Clin Exp Allergy 2011.
Older asthmatic patients have a 5-fold increased risk of mortality compared with younger adults. JACI, 2012.
Image source: OpenClipart.org, public domain.
Allergic diseases in the elderly http://goo.gl/pBLcf - "Immunosenescence" features http://goo.gl/8NQ9D
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