Advertisement

Treatment of Asthma in Older Adults with Significant Medical Comorbidities

  • Anil Nanda
  • Anita N. Wasan
Chapter

Abstract

Older adults with asthma usually have multiple medical comorbidities. These include cardiac disease, gastroesophageal reflux disease (GERD), depression, cognitive impairment, rhinitis/sinusitis, obesity, musculoskeletal conditions, as well as other lung conditions including chronic obstructive lung disease (COPD). Polypharmacy, including the use of complementary and alternative medications, is another issue with older adults. The association of these conditions with asthma is often underappreciated, and this can impact overall asthma diagnosis and therapy. As the population is aging worldwide, awareness and treatment of these multiple associated medical conditions are essential in providing complete care to the older adult asthma patient.

Keywords

Asthma Older adult Medical comorbidities Depression Rhinitis Sinusitis Treatment 

References

  1. 1.
    Hanania N, King M, Braman S, Saltoun C, Wise R, Enright P, et al. Asthma in the elderly: current understanding and future research needs-a report of a National Institute on Aging (NIA) workshop. J Allergy Clin Immunol. 2011;128:s4–24.CrossRefGoogle Scholar
  2. 2.
    Tsai C, Lee W, Hanania N, Camargo C. Age-related differences in clinical outcomes for acute asthma in the United States, 2006–2008. J Allergy Clin Immunol. 2012;129:1252–8.CrossRefGoogle Scholar
  3. 3.
    Soones T, Lin J, Wolf M, O’Conor R, Martynenko M, Wisnivesky J, et al. Pathways linking health literacy, health beliefs, and cognition to medication adherence in older adults with asthma. J Allergy Clin Immunol. 2017;139:804–9.CrossRefGoogle Scholar
  4. 4.
    Hsu J, Chen J, Mirabelli M. Risk factors associated with asthma-related emergency department and urgent care visits among older adults. J Allergy Clin Immunol. 2017;139:AB202.CrossRefGoogle Scholar
  5. 5.
    Hekking P, Amelink M, Wener R, Bouvy M, Bel E. Comorbidities in difficult-to-control asthma. J Allergy Clin Immunol Pract. 2017;17:473–7.Google Scholar
  6. 6.
    Baptist A, Busse P. Asthma over the age of 65: all’s well that ends well. J Allergy Clin Immunol Pract. 2018;6:764–73.CrossRefGoogle Scholar
  7. 7.
    Desai M, Oppenheimer J, Tashkin D. Asthma-chronic obstructive pulmonary disease overlap syndrome: what we know and what we need to find out. Ann Allergy Asthma Immunol. 2017;118:241–5.CrossRefGoogle Scholar
  8. 8.
    Siddiqui S, Guasconi A, Vestbo J, et al. Blood eosinophils: a biomarker of response to extrafine beclomethasone/formoterol in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015;192:523–5.CrossRefGoogle Scholar
  9. 9.
    Gooneratne N, Patel N, Corcoran A. Chronic obstructive pulmonary disease diagnosis and management in older adults. J Am Geriatr Soc. 2010;58:1153–62.CrossRefGoogle Scholar
  10. 10.
    Diette G, Krishnan J, Dominici F, Haponik E, Skinner E, Steinwachs D, et al. Asthma in older patients: factors associated with hospitalization. Arch Intern Med. 2002;162:1123–32.CrossRefGoogle Scholar
  11. 11.
    Baldassarri S, Toll B, Leone F. A comprehensive approach to tobacco dependence interventions. J Allergy Clin Immunol. 2015;3:481–8.CrossRefGoogle Scholar
  12. 12.
    Yeh J, Wei Y, Lin C, Hsu W. Association of asthma-chronic obstructive pulmonary disease overlap syndrome with coronary artery disease, cardiac dysrhythmia and heart failure: a population-based retrospective cohort study. BMJ Open. 2017;7:1–9.CrossRefGoogle Scholar
  13. 13.
    Coop C, Schapira R, Freeman T. Are ACE inhibitors and beta-blockers dangerous in patients at risk for anaphylaxis? J Allergy Clin Immunol Pract. 2017;5:1207–11.CrossRefGoogle Scholar
  14. 14.
    Battaglia S, Benfante A, Spatafora M, Scichilone N. Asthma in the elderly: a different disease? Breathe. 2016;12:18–28.CrossRefGoogle Scholar
  15. 15.
    Dart R, Gollub S, Lazar J, Nair C, Schroeder D, Woolf S. Treatment of systemic hypertension in patients with pulmonary disease. Chest. 2003;123:222–42.CrossRefGoogle Scholar
  16. 16.
    Korn S, Schumann C, Kropf C, Stoiber K, Thielen A, Taube C, et al. Effectiveness of omalizumab in patients 50 years and older with severe persistent allergic asthma. Ann Allergy Asthma Immunol. 2010;105:313–9.CrossRefGoogle Scholar
  17. 17.
    Tat T, Cilli A. Evaluation of long-term safety and efficacy of omalizumab in elderly patients with uncontrolled allergic asthma. Ann Allergy Asthma Immunol. 2016;117:546–9.CrossRefGoogle Scholar
  18. 18.
    Shimizu Y, Dobashi K, Kusano M, Mori M. Different gastoroesophageal reflux symptoms of middle-aged to elderly asthma and chronic obstructive pulmonary disease (COPD) pateints. J Clin Biochem Nutr. 2012;50:169–75.CrossRefGoogle Scholar
  19. 19.
    Mendelsohn A. The effects of reflux on the elderly. The problems with medications and interventions. Otolaryngol Clin North Am. 2018;51:779–87.CrossRefGoogle Scholar
  20. 20.
    Ross JA, Yang Y, Song PXK, Clark NM, Baptist AP. Quality of life, health care utilization, and control in older adults with asthma. J Allergy Clin Immunol Pract. 2013;1:157–62.CrossRefGoogle Scholar
  21. 21.
    Enright P, McClelland R, Newman A, Gottlieb D, Lebowitz M. Underdiagnosis and undertreatment of asthma in the elderly. Chest. 1999;116:603–13.CrossRefGoogle Scholar
  22. 22.
    Bella V, Pedone C, Catalano F, Zito A, Davi E, Palange S, et al. Asthma in the elderly: mortality rate and associated risk factors for mortality. Chest. 2007;132:1175–82.CrossRefGoogle Scholar
  23. 23.
    Radenne F, Verkindre C, Tonnel A. Asthma in the elderly. Rev Mal Respir. 2004;21:8s117–25.CrossRefGoogle Scholar
  24. 24.
    Connolly M, Yohannes A. The impact of depression in older patients with chronic obstructive pulmonary disease and asthma. Maturitas. 2016;92:9–14.CrossRefGoogle Scholar
  25. 25.
    Viera E, Brown E, Raue P. Depression in older adults: screening and referral. J Geriatr Phys Ther. 2014;37:24–30.CrossRefGoogle Scholar
  26. 26.
    Harpole L, Williams J, Olsen M, Stechuchak K, Oddone E, Callahan C, et al. Improving depression outcomes in older adults with comorbid medical illness. Gen Hosp Psychiatry. 2005;27:4–12.CrossRefGoogle Scholar
  27. 27.
    Bergeron C, Hamid Q. Relationship between asthma and rhinitis: epidemiologic, pathophysiologic, and therapeutic aspects. Allergy Asthma Clin Immunol. 2005;1(2):81–7.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Baptist A, Nyenhuis S. Rhinitis in the elderly. Immunol Allergy Clinics N America. 2016;36:343–57.CrossRefGoogle Scholar
  29. 29.
    Pinto J, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunology. 2010;6:10.CrossRefGoogle Scholar
  30. 30.
    Boulet L, Robitaille C, Deschesnes F, Villeneuve H, Boulay M. Comparative clinical, physiological, and inflammatory characteristics of elderly subjects with or without asthma and young subjects with asthma. Chest. 2017;152:1203–13.CrossRefGoogle Scholar
  31. 31.
    Beuther D, Weiss S, Sutherland E. Obesity and asthma. Am J Respir Crit Care Med. 2006;174:112–9.CrossRefGoogle Scholar
  32. 32.
    Xu K, Wisivesky J, Martynenko M, Mhango G, Busse P, Wolf M. Assessing the association of obesity and asthma morbidity in older adults. Ann Allergy Asthma Immunol. 2016;117:33–7.CrossRefGoogle Scholar
  33. 33.
    Baptist A, Hao W, Karamched K, Kaur B, Carpenter L, Song P. Distinct asthma phenotypes among older adults with asthma. J Allergy Clin Immunol Pract. 2018;6:244–9.PubMedGoogle Scholar
  34. 34.
    Shah R, Yang Y. Health and economic burden of obesity in elderly individuals with asthma in the United States. Popul Health Manag. 2015;18:186–91.CrossRefGoogle Scholar
  35. 35.
    Pradeepan S, Garrison G, Dixon A. Obesity in asthma: approaches to treatment. Curr Allergy Asthma Rep. 2013;13:434–42.CrossRefGoogle Scholar
  36. 36.
    Melani A. Management of asthma in the elderly patient. Clin Int Aging. 2013;8:913–22.CrossRefGoogle Scholar
  37. 37.
    Skloot G, Busse P, Braman S, Kovacs E, Dixon A, Vaz Fragoso CA, et al. An official American Thoracic Society workshop report: evaluation and management of asthma in the elderly. Ann Am Thorac Soc. 2016;11:2064–77.CrossRefGoogle Scholar
  38. 38.
    Maher R, Hanlon J, Hajjar E. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:1–11.CrossRefGoogle Scholar
  39. 39.
    O’Conor R, Wolf M, Smith S, Martynenko M, Vicencio D, Sano M, et al. Health literacy, cognitive function, proper use, and adherence to inhaled asthma controller medications among older adults with asthma. Chest. 2015;147:2418–25.Google Scholar
  40. 40.
    Kremers H, Larson D, Crowson C, Kremers W, Washington R, Steiner C, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015;97:1386–97.CrossRefGoogle Scholar
  41. 41.
    Chan E, Welsh C. Geriatric respiratory medicine. Chest. 1998;114:1704–33.CrossRefGoogle Scholar
  42. 42.
    Peron E, Gray S, Hanlon J. Medication use and functional status decline in older adults: a narrative review. Am J Geriatr Pharmacother. 2011;9:378–91.CrossRefGoogle Scholar
  43. 43.
    Burrowa B, Barbee R, Cline M, Knudson R, Lebowitz M. Characteristics of asthma among elderly adults in a sample of the general population. Chest. 1991;100:935–42.CrossRefGoogle Scholar
  44. 44.
    Radhakrishna N, Tay T, Hore-Lacy F, Stirling R, Hoy R, Dabscheck E, et al. Validated questionnaires heighten detection of difficult asthma comorbidities. J Asthma. 2017;54:294–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anil Nanda
    • 1
    • 2
  • Anita N. Wasan
    • 3
  1. 1.Asthma and Allergy CenterLewisville and Flower MoundTXUSA
  2. 2.Division of Allergy and ImmunologyUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Allergy and Asthma CenterMcLeanUSA

Personalised recommendations