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Late Onset Asthma

Epidemiology, Diagnosis and Treatment

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Abstract

Asthma is common among older persons, affecting approximately 4 to 8% of those above the age of 65 years. Despite its prevalence, late onset asthma may be misdiagnosed and inadequately treated, with important negative consequences for the patient’s health. The histopathology of late onset disease appears to be similar to that of asthma in general, with persistent airway inflammation a characteristic feature. It is less clear, however, that allergic exposure and sensitisation play the same role in the development of disease in adults as they do in children. Atopy is less common among those with late onset asthma, and the prevalence of elevated immunoglobulin E levels is lower among those aged over 55 years of age than younger patients. Occupational asthma is an aetiological consideration unique to adult onset disease, with important implications for treatment.

The differential diagnosis for cough, wheeze, and dyspnoea in the elderly is broad, and includes chronic obstructive bronchitis, bronchiectasis, congestive heart failure, lung cancer with endobronchial lesion and vocal cord dysfunction.

Keys to accurate diagnosis include a good history and physical examination, the demonstration of reversible airways obstruction on pulmonary function tests and a favorable response to treatment. Inhaled corticosteroid therapy is recommended for patients with persistent disease, and careful instruction in the use of metered-dose inhalers is particularly important for the elderly.

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References

  1. Enright PL, McClelland RL, Newman AB, et al. Underdiagnosis and undertreatment of asthma in the elderly. Chest 1999; 116: 603–13

    Article  PubMed  CAS  Google Scholar 

  2. National Heart, Lung, and Blood Institute Data Fact Sheet. Asthma statistics. January 1999. Bethesda (MD): National Heart, Lung, and Blood Institute, 1999

  3. Yunginger JW, Reed CE, O’Connell EJ, et al. A community-based study of the epidemiology of asthma: incidence rates, 1964–1983. Am Rev Respir Dis 1992; 146: 888–94

    PubMed  CAS  Google Scholar 

  4. Burrows B, Barbee R, Cline M. Characteristics of asthma among elderly adults in a sample of the general population. Chest 1991; 100: 935–41

    Article  PubMed  CAS  Google Scholar 

  5. Dyer CAE, Hill SL, Stockley RA, et al. Quality of life in elderly subjects with a diagnostic label of asthma from general practice registers. Eur Respir J 1999; 14: 39–45

    Article  PubMed  CAS  Google Scholar 

  6. Banerjee DK, Lee GS, Malik SK, et al. Underdiagnosis of asthma in the elderly. Br J Dis Chest 1987; 81: 23–9

    Article  PubMed  CAS  Google Scholar 

  7. Dow L, Coggon D, Campbell MJ, et al. The interaction between immunoglobin E and smoking in airflow obstruction in the elderly. Am Rev Respir Dis 1992; 146: 402–7

    PubMed  CAS  Google Scholar 

  8. Burrows B, Lebowitz MD, Barbee RA, et al. Findings before diagnosis of asthma among the elderly in a longitudinal study of a general population study. J Allergy Clin Immunol 1991; 88: 870–7

    Article  PubMed  CAS  Google Scholar 

  9. Burr ML, Charles TJ, Roy K, et al. Asthma in the elderly: an epidemiologic survey. BMJ 1979; 1: 1041–4

    Article  PubMed  CAS  Google Scholar 

  10. National Asthma Education and Prevention Program Working Group Report. Considerations for diagnosing and managing asthma in the elderly. Bethesda (MD): National Institutes of Health; 1996. NIH Publication No. 96-3662

  11. Sparrow D, O’Connor GT, Basner RC, et al. Predictors of the new onset of wheezing among middle aged and older men: the Normative Aging Study. Am J Respir Dis 1993; 147: 367–71

    CAS  Google Scholar 

  12. Reed CE. The natural history of asthma in adults: the problem of irreversibility. J Allergy Clin Immunol 1999; 103: 539–47

    Article  PubMed  CAS  Google Scholar 

  13. Dodge R, Burrows B. The prevalence and incidence of asthma and asthma-like symptoms in a general population sample. Am Rev Respir Dis 1980; 122: 567–75

    PubMed  CAS  Google Scholar 

  14. Broder I, Barlow PP, Horton RJM. The epidemiology of asthma and hay fever in a total community, Tecumseh, Michigan: I. Description of study and general findings. J Allergy 1962; 33: 315–23

    Google Scholar 

  15. Bauer B, Reed C, Yunginger J, et al. Incidence and outcomes of asthma in the elderly: a population-based study in Rochester, Minnesota. Chest 1997; 111: 303–10

    Article  PubMed  CAS  Google Scholar 

  16. Sly RM. Increases in deaths from asthma. Ann Allergy 1984; 106: 827–34

    Google Scholar 

  17. Sly RM. Changing asthma mortality. Ann Allergy 1994; 73: 259–68

    PubMed  CAS  Google Scholar 

  18. Weiss KB, Wagener DK. Changing patterns of asthma mortality: identifying target populations at high risk. JAMA 1990; 264: 1683–7

    Article  PubMed  CAS  Google Scholar 

  19. Barger LW, Vollmer WM, Felt RW. Further investigation into the recent increase in asthma death rates: a review of 41 asthma deaths in Oregon in 1982. Ann Aller 1988; 60: 31–9

    CAS  Google Scholar 

  20. Sobonya RE. Pathology of asthma in the elderly. In: Barbee RA, Bloom JW, editors. Asthma in the elderly. New York: Marcel Dekker Inc., 1997: 53–67 (Lenfant C, editor. Lung biology in health and disease series)

    Google Scholar 

  21. O’Connor GT, Sparrow D, Segal MR, et al. Smoking, atopy, and methacholine airway responsiveness among middle-aged and elderly men: the Normative Aging Study. Am Rev Respir Dis 1989; 140: 1520–6

    Article  PubMed  Google Scholar 

  22. Kradjan WA, Driesner NK, Abuan TH, et al. Effect of age on bronchodilator response. Chest 1992; 101: 1545–51

    Article  PubMed  CAS  Google Scholar 

  23. Sporik R, Holgate ST, Platts-Mills TA, et al. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood: a prospective study. N Engl J Med 1990; 323: 502–7

    Article  PubMed  CAS  Google Scholar 

  24. Barbee RA. Epidemiology and natural history. In: Barbee RA, Bloom JW, editors. Asthma in the elderly. New York: Marcel Dekker Inc., 1997: 1–31 (Lenfant C, editor. Lung biology in health and disease series).

    Google Scholar 

  25. Quadrelli SA, Roncoroni AJ. Is asthma in the elderly really different? Respiration 1998; 65: 347–53

    Article  PubMed  CAS  Google Scholar 

  26. Braham S, Kaemmerlan J, Davis S. Asthma in the elderly: a comparison between patients with recently acquired and longstanding disease. Am Rev Respir Dis 1991; 143: 336–40

    Google Scholar 

  27. Rackermann F. Intrinsic asthma. J Allergy 1940; 11: 147–62

    Article  Google Scholar 

  28. Lam S, Wong R, Yeung M. Nonspecific bronchial reactivity in occupational asthma. J Aller Clin Immunol 1979; 63: 28–34

    Article  CAS  Google Scholar 

  29. Chan-Yeung M, Malo JL. Occupational asthma. N Engl J Med 1995; 333: 107–12

    Article  PubMed  CAS  Google Scholar 

  30. Chan-Yeung M. Occupational asthma. Chest 1990; 98 (5 Suppl.): 148–61s

    Article  Google Scholar 

  31. Schachter EN, Doyle CA, Beck GJ. A prospective study of asthma in a rural community. Chest 1984; 85: 623–30

    Article  PubMed  CAS  Google Scholar 

  32. Peat J, Woolcock A, Cullen K. Rate of decline of lung function in subjects with asthma. Eur J Respir Dis 1987; 70: 171–9

    PubMed  CAS  Google Scholar 

  33. Almind M, Viskum K, Evald T, et al. Seven year follow-up study of 343 adults with bronchial asthma. Dan Med Bull 1992; 39: 561–5

    PubMed  CAS  Google Scholar 

  34. Burrows B, Bloom J, Traver G, et al. The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med 1987; 317: 1309–14

    Article  PubMed  CAS  Google Scholar 

  35. Reed CE. The role of allergy and airway inflammation. In: Barbee RA, Bloom JW, editors. Asthma in the elderly. New York: Marcel Dekker Inc., 1997: 33–51 (Lenfant C, editor. Lung biology in health and disease series)

    Google Scholar 

  36. Weiss KB, Gergen PJ, Wagener DK. Breathing better or wheezing worse? The changing epidemiology of asthma morbidity and mortality. Annu Rev Publ Health 1991; 14: 491–513

    Article  Google Scholar 

  37. Centers for Disease Control. Asthma, United States, 1982–1992. MMWR Morb Mortal Wkly Rep 1995; 43: 952–5

    Google Scholar 

  38. Horn CR, Cochrane GM. An audit of morbidity associated with chronic asthma in a general practice. Respir Med 1989; 83: 71–5

    Article  PubMed  CAS  Google Scholar 

  39. American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995; 152: 1107–36

    Google Scholar 

  40. Weiner P, Magadle R, Waizman J, et al. Characteristics of asthma in the elderly. Eur Respir J 1998; 12: 564–8

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  42. Coughlin SS, Metayer C, McCarthy EP, et al. Respiratory illness, beta-agonists, and risk of idiopathic dilated cardiomyopathy: the Washington, DC, Dilated Cardiomyopathy Study. Am J Epidemiol 1995; 142: 395–403

    PubMed  CAS  Google Scholar 

  43. Barbee R, Lebowitz M, Thompson H, et al. Immediate skin-test reactivity in a general population sample. Ann Intern Med 1976; 84: 129–33

    PubMed  CAS  Google Scholar 

  44. Connolly M, Kelly W, Walters E. An assessment of methacholine inhalation tests in elderly asthmatics. Age Aging 1988; 17: 123–8

    Article  CAS  Google Scholar 

  45. Hopp E, Bewtra A, Nair N, et al. The effect of age on methacholine responsiveness. J Allergy Clin Immunol 1985; 76: 609–13

    Article  PubMed  CAS  Google Scholar 

  46. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340: 685–91

    Article  PubMed  CAS  Google Scholar 

  47. Holm K, Spencer C. Bupropion: a review of its use in the management of smoking cessation. Drugs 2000; 59: 1007–24

    Article  PubMed  CAS  Google Scholar 

  48. Expert panel report 2: Guidelines for the diagnosis and management of asthma. 2nd ed. Bethesda (MD): National Institutes of Health 1997, NIH Publication No. 97-4051

  49. Connolly M, Crowley J, Nielson C, et al. Peripheral mononuclear leukocyte adrenoceptors and non-specific bronchial responsiveness to methacholine in young and elderly normal subjects and asthmatic patients. Thorax 1994; 49: 26–32

    Article  PubMed  CAS  Google Scholar 

  50. Ullah M, 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 

  51. Barros MJ, Rees PJ. Bronchodilator responses to salbutamol followed by ipratropium bromide in partially reversible airflow obstruction. Respir Med 1990; 84: 371–5

    Article  PubMed  CAS  Google Scholar 

  52. Lipworth BJ, Struthers AD, McDevitt DG. Tachyphylaxis to systemic but not to airway responses during prolonged therapy with high dose inhaled salbutamol in asthmatics. Am Rev Respir Dis 1989; 140: 586–92

    PubMed  CAS  Google Scholar 

  53. Physicians Desk Reference. Montvale (NJ): Medical Economics Company, 2000

  54. Gross NJ, Petty TL, Friedman M, et al. Dose response to ipratropium as a nebulized solution in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1989; 139: 1188–91

    PubMed  CAS  Google Scholar 

  55. Pauwels RA, Lofdahl C-G, Laitinen LA, et al. Effect of long-term treatment with inhaled budesonide in patients with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med 1999; 340: 1948–53

    Article  PubMed  CAS  Google Scholar 

  56. Vestbo J, Sorenson T, Lange P, et al. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 1999; 353: 1819–23

    Article  PubMed  CAS  Google Scholar 

  57. Garbe E, LeLorier J, Boivin JF, et al. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. JAMA 1997; 277: 722–7

    Article  PubMed  CAS  Google Scholar 

  58. Hanania NA, Chapman KR, Sturtridge WC, et al. Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids. J Allergy Clin Immunol 1995; 96 (5 Pt 1): 571–9

    Article  PubMed  CAS  Google Scholar 

  59. Cumming RG, Mitchell P, Leeder SR. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 1997; 337: 8–14

    Article  PubMed  CAS  Google Scholar 

  60. Simons FER, Persaud MP, Gillespie CA, et al. Absence of posterior subcapsular cataracts in young patients treated with inhaled glucocorticoids. Lancet 1993; 342; 776–8

    Article  PubMed  CAS  Google Scholar 

  61. Abuekteish F, Kirkpatrick JNP, Russell G. Posterior subcapsular cataract and inhaled corticosteroid therapy. Thorax 1995; 50: 674–6

    Article  PubMed  CAS  Google Scholar 

  62. Toogood JH, Markov AE, Baskerville J, et al. Association of ocular cataracts with inhaled and oral steroid therapy during long-term treatment of asthma. J Allergy Clin Immunol 1993; 91: 571–9

    Article  PubMed  CAS  Google Scholar 

  63. Weinberger M, Hendeles L. Theophylline in asthma. N Engl J Med 1996; 334: 1380–8

    Article  PubMed  CAS  Google Scholar 

  64. 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 

  65. Greening AP, Ind PW, Northfield M, et al. Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet 1994; 344: 219–24

    Article  PubMed  CAS  Google Scholar 

  66. Gonzalez JP, Brogden RN. Nedocromil sodium: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of reversible obstructive airways disease. Drugs 1987; 34: 560–77

    Article  PubMed  CAS  Google Scholar 

  67. Drazen JM, Israel E, O’Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway [published errata appear in N Engl J Med 1999 Feb 25; 340: 663 and 1999 Nov 18; 341: 1632]. N Engl J Med 1999; 340: 197–206

    Article  PubMed  CAS  Google Scholar 

  68. Israel E, Cohn J, Dube L, et al. Effect of treatment with zileuton, a 5-lipoxygenase inhibitor, in patients with asthma: a randomized controlled trial. JAMA 1996; 275: 931–6

    Article  PubMed  CAS  Google Scholar 

  69. Wechsler ME, Garpestad E, Flier SR, et al. Pulmonary infiltrates, eosinophilia, and cardiomyopathy following corticosteroid withdrawal in pateints with asthma receiving zafirlukast. JAMA 1998; 279: 455–7

    Article  PubMed  CAS  Google Scholar 

  70. Wechsler ME, Finn D, Gunawardena D, et al. Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma. Chest 2000; 117: 708–13

    Article  PubMed  CAS  Google Scholar 

  71. Adkins JC, Brogden RN. Zafirlukast: a review of its pharmacology and therapeutic potential. Drugs 1998; 55: 121–44

    Article  PubMed  CAS  Google Scholar 

  72. Van Hecken A, Depre M, Verbesselt R, et al. Effect of montelukast on the pharmacokinetics and pharmacodynamics of warfarin in healthy volunteers. J Clin Pharmacol 1999; 39: 495–500

    PubMed  Google Scholar 

  73. Kendall MJ. Clinical relevance of pharmacokinetic differences between beta blockers. Am J Cardiol 1997; 80: 15–9J

    Article  Google Scholar 

  74. Odeh M, Oliven A, Bassan H. Timolol eyedrop-induced fatal bronchospasm in an asthmatic patient. J Fam Pract 1991; 32: 97–8

    PubMed  CAS  Google Scholar 

  75. Semple PF. Putative mechanism of cough after treatment with angiotensin-converting enzyme inhibitors. J Hypertens 1995; 13Suppl. 3: S17–21

    Article  CAS  Google Scholar 

  76. Chapman K, Love L, Brubaker H. A comparison of breath-actuated and conventional metered-dose inhaler inhalation techniques in elderly subjects. Chest 1993; 104: 1332–7

    Article  PubMed  CAS  Google Scholar 

  77. Newman SP, Millar AB, Lennard-Jones TR, et al. Improvement of pressurized aerosol deposition with nebuhaler spacer device. Thorax 1991; 46: 712–6

    Article  PubMed  CAS  Google Scholar 

  78. Newman SP, Weisz AWB, Talaee N, et al. Improvement of drug delivery with a breath actuated pressurized aerosol for patients with poor inhaler technique. Thorax 1984; 39: 935–41

    Article  PubMed  CAS  Google Scholar 

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Kitch, B.T., Levy, B.D. & Fanta, C.H. Late Onset Asthma. Drugs & Aging 17, 385–397 (2000). https://doi.org/10.2165/00002512-200017050-00005

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