What are the special features of asthma in the elderly?
Asthma can occur in older people (age greater than 65 years) under two circumstances:
- It was present since younger days, and has persisted.
- It first appears in old age.
In either situation, it can present certain peculiar problems:
- Symptoms of asthma in the elderly are somewhat different.
- “Breathlessness” is assumed to be part of normal aging and thus no medical help is
- Other age related diseases may be present which make the diagnosis difficult.
- The patient may be taking other drugs which interfere with asthma, or its treatment.
- Asthma in the elderly tends to be more severe and could become life threatening.
- The usual asthma medications can have more serious side effects in the elderly.
- Mental impairment makes taking the drugs difficult and challenging.
- Physical impairment, for instance hand arthritis, makes using inhalers difficult.
Let us analyze these issues from two perspectives: the patient’s and the doctor’s.
The patient’s perspective:
When asthma starts in older age, the symptoms like breathlessness, cough and wheeze are usually thought by the patient to be normal symptoms of aging. No diagnosis is sought; no diagnosis is made and no treatment started. As a result the disease advances and lung damage occurs. Once the diagnosis is made and some treatment is to be started, there is a natural disinclination on the part of the patient to start new medicines since he/she is already on so many other medicines (like blood pressure or diabetes). In such a situation the patient may prefer to suffer some symptoms rather than take medicines which may cause side effects and are also costly.
The Doctor’s perspective:
When faced with an elderly person who has cough and wheeze that may be due to asthma, the
doctor also faces tough choices. “Is this really asthma? Could it be a manifestation of heart
disease? Could it be something more serious like cancer? How much should I investigate it,
knowing that investigations are expensive?” These are some of the issues the doctor has to
carefully consider and weigh. Yet you cannot err by missing something.
The patient and the doctor can be on the “same page” if they openly discuss the issues and then
collectively decide the future course of action.
I often see a remarkable improvement in symptoms in elderly patients on starting treatment –
many a time much more than I or the patient had expected, to the delight of both!!