When people think of asthma, they often associate it with children. But did you know that asthma is increasing among people over 65 years of age? Unfortunately, asthma cases among people over 65 often go undiagnosed, or even misdiagnosed.

Recognizing Asthma

Unlike young people with asthma, whose main symptom is wheezing, seniors usually complain of a chronic cough. For this reason, asthma in older adults may be overlooked or misdiagnosed as the common cold or cough. Other symptoms may include wheezing, shortness of breath, fatigue, and weight loss.

Asthma in people over 65 often occurs among former smokers and those with emphysema, chronic bronchitis, or other conditions related to chronic obstructive pulmonary disease (COPD). Sometimes, it is hard to distinguish asthma from other conditions. For example, pulmonary edema, which is caused by heart failure, can cause asthma-like symptoms, such as wheezing. This is sometimes referred to as "cardiac asthma." A correct diagnosis is critical because the treatment of the two diseases is very different.

Triggers

Viral respiratory illnesses (e.g., influenza and the common cold virus) and tobacco smoke are the main triggers for adults with asthma. However, common asthma culprits such as dust mites, pet dander, pollen, and molds can also affect people over 65, especially those who spend a lot of time in the home. Lack of exercise or healthy foods may also contribute to poor lung health.

Treatment

Before you begin any asthma treatment plan, discuss with your doctor any other medications you are taking. Some asthma drugs have adverse side effects when mixed with other drugs. Your doctor may provide a written treatment plan that helps you keep track of your medications.

The National Asthma Education and Prevention Program (NAEPP) has conducted a Systematic Review of the Evidence (SRE) of the long-term safety of certain asthma medications. Many physicians rely on this review and the accompanying guidelines when managing asthma. Nevertheless, it should be noted that the SRE may not apply to elderly adults. For instance, the review looks at the impact of steroid medications on height growth (not directly applicable to the aging), but not at issues for the aging, including bone mineral density and eye side effects (such as cataracts) that are likely to occur more frequently as age increases.

References

National Asthma Education and Prevention Program Expert Panel Report: guidelines for the diagnosis and management of asthma update on selected topics -- 2002. J Allergy Clin Immunol. 2002 Nov;110(Suppl 5):S141-219.

National Asthma Education and Prevention Program Expert Panel Report 2: guidelines for the diagnosis and management of asthma. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute; 1997 Jul. NIH Publications 97-4051.

Williams SG, Schmidt DK, Redd SC, Storms W. Key clinical activities for quality asthma care: recommendations of the National Asthma Education and Prevention Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.