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Improving Outcomes in Elderly Patients with Asthma

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Abstract

Although often regarded as a disease of childhood, asthma is common in elderly people. Although recent figures show a decline over the past few years in the number of asthma deaths in children and younger adults, the same is not true of older adults, in whom most asthma deaths occur.

Differences between asthma in young and old patients are seen not only in response to treatment. The nonspecific presentation of asthma in elderly adults means that the diagnosis of asthma is difficult to make. In addition, research suggests that physicians are reluctant to use spirometry and measurement of reversibility when investigating respiratory symptoms in old people. This leads to a tendency to label breathless or wheezy elderly patients as having chronic obstructive pulmonary disease (COPD) rather than asthma. In turn, patients with a diagnosis of COPD are less likely to be treated with bronchodilators and corticosteroids.

Treatment guidelines for the management of asthma in children and younger adults may need to be adapted when applied to older patients. Reduced perception of bronchoconstriction may lead to underuse of bronchodilators prescribed ‘as required’. The bronchodilator response to β2-agonists is attenuated as part of the normal aging process, and other groups of bronchodilator medications should be considered. Inhaler technique can be a particular problem in elderly patients with asthma, requiring careful choice of inhaler device. However, the frequent presence of multiple pathology and multiple medication in this age group enhances the risk of adverse effects from oral preparations, and so the inhaled route should be preferred wherever possible.

Underestimation of the severity of an acute exacerbation of asthma by both patient and doctor has been suggested as a contributory factor to poor outcome in older people. Since the cardiovascular responses to hypoxia and bronchoconstriction tend to diminish with increasing age, objective measures of asthma severity (peak flow monitoring and blood gas estimation) are essential in this age group.

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References

  1. Campbell MJ, Cogman GR, Holgate ST, et al. Age specific trends in asthma mortality in England and Wales, 1982–1995: results of an observational study. BMJ 1997; 314: 1439–41

    Article  PubMed  CAS  Google Scholar 

  2. British Thoracic Society. The British guidelines on asthma management: 1995 review and position statement. Thorax 1997; 52Suppl. 1: S1–21

    Google Scholar 

  3. Allen SC. Missed asthma: a study of 13 old people. Br J Clin Pract 1988; 42: 158–60

    PubMed  CAS  Google Scholar 

  4. Connolly MJ, Crowley JJ, Charan NB, et al. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax 1992; 47: 410–3

    Article  PubMed  CAS  Google Scholar 

  5. Ghosh SK, Stewart DA, MacPhee JGA. Diagnosis and management of obstructive airways disease in the elderly. Age Ageing 1992; 21Suppl. 2: 10

    Google Scholar 

  6. Brown PJ, Greville HW, Finucane KE. Asthma and irreversible airflow obstruction. Thorax 1984; 39: 131–9

    Article  PubMed  CAS  Google Scholar 

  7. Rudd R. Corticosteroids in chronic bronchitis. BMJ 1984; 288: 1553–4

    Article  PubMed  CAS  Google Scholar 

  8. Dodge R, Cline MG, Burrows B. Comparisons of asthma, emphysema, and chronic bronchitis diagnoses in a general population sample. Am Rev Respir Dis 1986; 133: 981–6

    PubMed  CAS  Google Scholar 

  9. Littlejohns P, Ebrahim S, Anderson R. Prevalence and diagnosis of chronic respiratory symptoms in adults. BMJ 1989; 298: 1556–60

    Article  PubMed  CAS  Google Scholar 

  10. British Thoracic Society. BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997; 52Suppl. 5: S1–28

    Google Scholar 

  11. Roberts SJ, Bateman DN. Which patients are prescribed inhaled anti-asthma drugs? Thorax 1994; 49: 1090–5

    Article  PubMed  CAS  Google Scholar 

  12. Littlejohns P, Ebrahim S, Anderson R. Treatment of adult asthma: is the diagnosis relevant? Thorax 1989; 44: 797–802

    Article  PubMed  CAS  Google Scholar 

  13. Stokes TC, Shaylor JM, O’Reilly JF, et al. Assessment of steroid responsiveness in patients with chronic airflow obstruction. Lancet 1982; II: 345–8

    Article  Google Scholar 

  14. Wardman AG, Simpson FG, Knox AJ, et al. The use of high dose inhaled beclomethasone dipropionate as a means of assessing steroid responsiveness in obstructive airways disease. Br J Dis Chest 1988; 82: 168–71

    Article  PubMed  CAS  Google Scholar 

  15. Tanizaki Y. Improvement of ventilatory function by spa therapy in patients with intractable asthma. Acta Med Okayama 1986; 40: 55–9

    PubMed  CAS  Google Scholar 

  16. Stenius-Aarniala B, Huttunen JK, Pyhala R, et al. Lack of clinical exacerbations in adults with chronic asthma after immunization with killed influenza virus. Chest 1986; 89: 786–9

    Article  PubMed  CAS  Google Scholar 

  17. Department of Health. Immunisation against infectious disease. London: HMSO, 1992

    Google Scholar 

  18. Kendrick AH, Higgs CMB, Whitfield MJ, et al. Accuracy of perception of severity of asthma: patients treated in general practice. BMJ 1993; 307: 422–4

    Article  PubMed  CAS  Google Scholar 

  19. Stableforth DE. Asthma mortality and physician competence. J Allergy Clin Immunol 1987; 80: 463–6

    Article  PubMed  CAS  Google Scholar 

  20. Connolly MJ, Crowley JJ, Charan NB, et al. Impaired bronchodilator response to inhaled albuterol in elderly men and women. Chest 1995; 108: 401–6

    Article  PubMed  CAS  Google Scholar 

  21. Ullah MI, Newman GB, Saunders KB. Influence of age on response to ipratropium and salbutamol in asthma. Thorax 1981; 36: 523–9

    Article  PubMed  CAS  Google Scholar 

  22. Orehek J, Gayrard P, Grimaud C, et al. Patient error in use of bronchodilator metered aerosols [letter]. BMJ 1976; 1: 76

    Article  Google Scholar 

  23. Burton AJ. Asthma inhalation devices: what do we know? BMJ 1984; 288: 1650–1

    Article  PubMed  CAS  Google Scholar 

  24. Allen SC, Prior A. What determines whether an elderly patient can use a metered dose inhaler correctly? Br J Dis Chest 1986; 80: 45–9

    Article  PubMed  CAS  Google Scholar 

  25. Armitage JM, Williams SJ. Inhaler technique in the elderly. Age Ageing 1988; 17: 275–8

    Article  PubMed  CAS  Google Scholar 

  26. Allen SC. Competence thresholds for the use of inhalers in people with dementia. Age Ageing 1997; 26: 83–6

    Article  PubMed  CAS  Google Scholar 

  27. Connolly MJ. Inhaler technique in elderly patients — comparison of metered dose inhalers and large volume spacer devices. Age Ageing 1995; 24: 190–2

    Article  PubMed  CAS  Google Scholar 

  28. Harvey J, Williams JG. Randomised cross-over comparison of five inhaler systems for bronchodilator therapy. Br J Clin Pract 1992; 46: 249–51

    PubMed  CAS  Google Scholar 

  29. Diggory P, Bailey R, Vallon A. Effectiveness of inhaled bronchodilator delivery systems for elderly patients. Age Ageing 1991; 20: 379–82

    Article  PubMed  CAS  Google Scholar 

  30. Selroos O, Halme M. The effect of a Volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from a metered dose inhaler and dry powder inhaler. Thorax 1991; 46: 891–4

    Article  PubMed  CAS  Google Scholar 

  31. O’Callaghan C, Barry P. Spacer devices in the treatment of asthma. BMJ 1997; 314: 1061–2

    Article  PubMed  Google Scholar 

  32. Toogood JH, Jennings B, Greenway RW, et al. Candidiasis and dysphonia complicating beclomethasone treatment of asthma. J Allergy Clin Immunol 1980; 65: 145–53

    Article  PubMed  CAS  Google Scholar 

  33. Gaddie J, Reid IW, Skinner C, et al. Aerosol beclomethasone dipropionate: a dose-response study in chronic bronchial asthma. Lancet 1973; II: 280–7

    Article  Google Scholar 

  34. Wilding P, Clark M, Thompson Coon J, et al. Effect of long term treatment with salmeterol on asthma control: a double blind, randomised crossover study. BMJ 1997; 314: 1441–6

    Article  PubMed  CAS  Google Scholar 

  35. Crane J, Pearce N, Flatt A, et al. Prescribed fenoterol and death from asthma in New Zealand, 1981–83: case-control study. Lancet 1989; I: 917–22

    Article  Google Scholar 

  36. Sears MR, Taylor DR, Print CG, et al. Regular inhaled beta-agonist treatment in bronchial asthma. Lancet 1990; 336: 1391–6

    Article  PubMed  CAS  Google Scholar 

  37. Jenkins MM, Price K, Pounsford JC, et al. Safety and efficacy of salmeterol in elderly patients with asthma [abstract]. Am Rev Respir Dis 1992; 145: A65

    Article  Google Scholar 

  38. Chapman KR, Kesten S, Szalai JP. Regular vs as needed inhaled salbutamol in asthma control. Lancet 1994; 343: 1379–82

    Article  PubMed  CAS  Google Scholar 

  39. Shannon M, Lovejoy FH. The influence of age vs peak serum concentration on life-threatening events after chronic theophylline intoxication. Arch Intern Med 1990; 150: 2045–8

    Article  PubMed  CAS  Google Scholar 

  40. Shannon M. Predictors of major toxicity after theophylline overdose. Ann Intern Med 1993; 119: 1161–7

    PubMed  CAS  Google Scholar 

  41. British Thoracic Society. Current best practice for nebuliser treatment. Thorax 1997; 52Suppl. 2: S1–106

    Google Scholar 

  42. Hall SK. Acute angle-closure glaucoma as a complication of combined beta-agonist and ipratropium bromide therapy in the emergency department. Ann Emerg Med 1994; 23: 884–7

    Article  PubMed  CAS  Google Scholar 

  43. O’Driscoll BR, Kalra S, Wilson M, et al. Double-blind trial of steroid tapering in acute asthma. Lancet 1993; 341: 324–7

    Article  PubMed  Google Scholar 

  44. Braman SS, Corrao WM, Kaemmerlen JT. The clinical outcome of asthma in the elderly: a 7-year follow-up study. Ann N Y Acad Sci 1991; 629: 449–50

    Article  PubMed  CAS  Google Scholar 

  45. O’Byrne PM, Israel E, Drazen JM. Antileukotrienes in the treatment of asthma. Ann Intern Med 1997; 127: 472–80

    PubMed  Google Scholar 

  46. Sampson A, Holgate A. Leukotriene modifiers in the treatment of asthma. BMJ 1998; 316: 1257–8

    Article  PubMed  CAS  Google Scholar 

  47. Petheram IS, Jones DA, Collins JV. Assessment and management of acute asthma in the elderly: a comparison with younger asthmatics. Postgrad Med J 1982; 58: 149–51

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Geriatric Medicine, Cornwall Healthcare Trust, Camborne/Redruth Community Hospital, Redruth, Cornwall, England

    Deborah S. Renwick

  2. Robert Barnes Rehabilitation Centre, University of Manchester and Central Manchester Healthcare Trust, Cheadle, Stockport, England

    Martin J. Connolly

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  1. Deborah S. Renwick
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  2. Martin J. Connolly
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Renwick, D.S., Connolly, M.J. Improving Outcomes in Elderly Patients with Asthma. Drugs & Aging 14, 1–9 (1999). https://doi.org/10.2165/00002512-199914010-00001

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