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Facing asthma during the golden years
Facing Asthma During the Golden Years ByTeresaThom
More Seniors are Battling (and Controlling) Asthma Part I M
arvine is a 73-year-old woman who has been rel-
atively healthy all her life. This is a fact of which she is proud. Late last year, however, she had a bout with bronchitis and never seemed to shake it. Two months after her first symptoms appeared she wasn't better. In fact, she felt worse. She had developed more symptoms, including wheezing, shortness of breath and a severe cough that woke her most nights. When she went back to her health care provider, she expected a prescription for yet another antibiotic. She was not prepared for what she received - - a diagnosis of asthma. How could this be at her age? She doesn't have allergies, nor did she as a child. She doesn't remember a history of asthma in her family. 6
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Marvine's story is not uncommon. Asthma is no longer considered a disease of the young. It affects all age groups, from infants to senior citizens. Indeed, studies show a trend toward an increasing number of asthma cases in the elderly, especially older women. Almost 10 percent of the 17.3 million Americans now estimated to have asthma - - some 1.65 million - are thought to be over age 65. Their asthma may have persisted since childhood, recurred since childhood, started in adulthood and persisted, or developed later in life. Why Seniors Develop Asthma
Reasons for the rise in asthma prevalence among older people are speculative. Many experts believe that a lifetime of exposure to inflammation~ provoking substances in the environment plays a role. This, combined with normal age-related physical changes, may increase their susceptibility to the disease.
Recurrence of childhood asthma is definitely adding to the number of seniors with asthma. Many people are convinced they "outgrew" their asthma as adolescents or young adults. Asthma experts realize now, however, that it typically does not just "go away." The lucky ones may have years during which their asthma is inactive or very mild. Then, at some point in adult-
hood, some event may trigger a reaction and active asthma is back. This event may be a severe respiratory infection. It may be high exposure to allergens, such as getting a pet. (See artide on outgrowing asthma on page 12.) Late-onset asthma (LOA) is asthma that truly develops later in life as opposed to recurring childhood asthma. It also often occurs, as in Marvine's case, after a severe infection, such as bronchitis or pneumonia. Many have neither a family history of the disease nor an allergic component. These individuals do, however, often have related conditions that are known to trigger asthma. These may indude sinus infections, nasal polyps, and/or a sensitivity to sulfites, aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Gastroesophageal reflux disease (GERD), or heartburn, often plays a significant role in cases of late-onset asthma. Other factors that either trigger or worsen asthma in seniors include specific occupational exposures, severe viral infections, cold air, exposure to indoor or outdoor air pollutants, and exercise. Although allergic asthma seems to be less common in older people, allergies can still play a role. A person with childhood allergies may develop allergic asthma later in life. This is especially likely if there is a family history of asthma. Scientists recently discovered that there might be allergic predictors of future asthma. Studies have shown that those allergic to pollen, pets (especially cats) or dust mites may be at a higher risk of developing asthma. ASTHMA
MAGAZINE
to
Older Women May Be More Susceptible
Recent studies suggest that older women may be more likely to develop asthma than older men. The hormones estrogen and progesterone seem to play a role, affecting airway function and inflammation. Postmenopausal women who are on hormone replacement therapy (HRT) - - estrogen with or without progesterone - - are 50 percent more likely than those not on H R T to develop asthma (AmericanJournal of
Respiratory Critical CareMedicine, 1995;152:1183 -1188). Smaller airway size, a trait specific to females, may also account for increased asthma severity in older women. Smaller airways may become blocked more easily and to a greater extent. Challenges Diagnosing
in Asthma
Asthma is often underdiagnosed or misdiagnosed in seniors. This may be partially due to the continuing misperception that the condition is uncommon in this age group. Also, coexisting medical conditions, which are common in older people, can make asthma more difficult to diagnose and treat. Symptoms from other subscribe
call
1.800.527.3284
7
medical conditions can mask or hide the existence of asthma. The symptoms of some diseases actually mimic asthma. Add the possibility of shared or overlapping symptoms, and the process can be further muddled. For example, it is sometimes difficult t o differentiate asthma from chronic obstructive pulmonary disease (COPD). Wheezing, coughing and mucus production are common symptoms of both conditions. COPD, a general term that includes emphysema and chronic bronchitis, is typically caused by a lifetime of smoking. In cases where there are coexisting medical conditions, it is generally recommended that the person see an asthma specialist. Diagnosing asthma in older people can be a challenge - - much like solving a puzzle. Medical examination and tests can provide clues to piecing together that puzzle. These procedures include a thorough medical history, physical examination, a study of nasal and mucus secretions, a chest xray, lung function tests and allergy tests, when indicated. Sometimes, doctors must work backwards by ruling out other conditions first. Evaluating a person's response to a trial asthma therapy can also be part of the diagnostic process. Treatment
Once it is determined that a person has asthma, medical management of seniors is similar to that for all asthmatics. This includes avoidance of allergens and irritants that can trigger symptoms, therapy with medications and sometimes immunotherapy (or "allergy shots"). A personalized asthma action plan helps seniors selfmanage their condition and tells them when to seek emergency help. With seniors, however, the same diseases that interfered with diagnosing asthma may complicate treatment. Warren V. Filley, MD, a practicing allergist and clinical associate professor of medicine at The University of Oklahoma Health 8
ASTHMA MAGAZINE
to
subscribe
Sciences Center, says the biggest challenge he encounters treating older asthmatics is the tendency for multiple disease states to require multiple medications. "The potential for side effects and drug interactions is often enormous." Unfortunately, some medications taken to treat a coexisting illnesses can actually cause or worsen asthma symptoms. For example, many older people take medicines called beta blockers to treat high blood pressure and other heart conditions. But these medications can increase asthma symptoms. Aspirin, often taken to relieve or control symptoms of arthritis, can be a potent asthma trigger for those who are sensitive to it. Conversely, some asthma medications can complicate other medical conditions. Older asthma patients, therefore, should be monitored closely during asthma treatment. It is important to ensure that prescribed medications are safe and effective. Patients should be monitored for potential drug interactions or side effects. There needs to be especially good communication between seniors with asthma and their health care provider. It is important for patients to inform their health care provider of all the medications they are taking for various conditions. call
1.800.527.3284
Also, Dr. Filley recommends that patients write down questions they have concerning their health. They should also make a note of symptoms they have noticed over the course of treatment - - whether or not they think they are asthma-related. This should be brought to the next appointment with their health care provider and discussed thoroughly. Seniors Do Get
With Asthma Better
The silver lining of late-onset asthma is that it is treatable and usually reversible. It may not be quite as reversible as it is in a younger counterpart, Dr. Filley says, but older people can still get significant relief from symptoms and often improved lung function once proper treatment is started. Clearly, the key to effective asthma treatment in all age groups is a prompt diagnosis and aggressive treatment beginning as early as possible in the disease process.
Teresa Thorn is a freelance writer living in Oklahoma City, Oklahoma. She specializes in medical and healthrelated topics. Look for part II of this series on seniors with asthma in the July/August issue of Asthma Magazine.
More Seniors are Battling (and Controlling) Asthma Part I M
arvine is a 73-year-old woman who has been rel-
atively healthy all her life. This is a fact of which she is proud. Late last year, however, she had a bout with bronchitis and never seemed to shake it. Two months after her first symptoms appeared she wasn't better. In fact, she felt worse. She had developed more symptoms, including wheezing, shortness of breath and a severe cough that woke her most nights. When she went back to her health care provider, she expected a prescription for yet another antibiotic. She was not prepared for what she received - - a diagnosis of asthma. How could this be at her age? She doesn't have allergies, nor did she as a child. She doesn't remember a history of asthma in her family. 6
] ASTHMAMAGAZINE
to
subscribe
call
1.800.527.3284
Marvine's story is not uncommon. Asthma is no longer considered a disease of the young. It affects all age groups, from infants to senior citizens. Indeed, studies show a trend toward an increasing number of asthma cases in the elderly, especially older women. Almost 10 percent of the 17.3 million Americans now estimated to have asthma - - some 1.65 million - are thought to be over age 65. Their asthma may have persisted since childhood, recurred since childhood, started in adulthood and persisted, or developed later in life. Why Seniors Develop Asthma
Reasons for the rise in asthma prevalence among older people are speculative. Many experts believe that a lifetime of exposure to inflammation~ provoking substances in the environment plays a role. This, combined with normal age-related physical changes, may increase their susceptibility to the disease.
Recurrence of childhood asthma is definitely adding to the number of seniors with asthma. Many people are convinced they "outgrew" their asthma as adolescents or young adults. Asthma experts realize now, however, that it typically does not just "go away." The lucky ones may have years during which their asthma is inactive or very mild. Then, at some point in adult-
hood, some event may trigger a reaction and active asthma is back. This event may be a severe respiratory infection. It may be high exposure to allergens, such as getting a pet. (See artide on outgrowing asthma on page 12.) Late-onset asthma (LOA) is asthma that truly develops later in life as opposed to recurring childhood asthma. It also often occurs, as in Marvine's case, after a severe infection, such as bronchitis or pneumonia. Many have neither a family history of the disease nor an allergic component. These individuals do, however, often have related conditions that are known to trigger asthma. These may indude sinus infections, nasal polyps, and/or a sensitivity to sulfites, aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Gastroesophageal reflux disease (GERD), or heartburn, often plays a significant role in cases of late-onset asthma. Other factors that either trigger or worsen asthma in seniors include specific occupational exposures, severe viral infections, cold air, exposure to indoor or outdoor air pollutants, and exercise. Although allergic asthma seems to be less common in older people, allergies can still play a role. A person with childhood allergies may develop allergic asthma later in life. This is especially likely if there is a family history of asthma. Scientists recently discovered that there might be allergic predictors of future asthma. Studies have shown that those allergic to pollen, pets (especially cats) or dust mites may be at a higher risk of developing asthma. ASTHMA
MAGAZINE
to
Older Women May Be More Susceptible
Recent studies suggest that older women may be more likely to develop asthma than older men. The hormones estrogen and progesterone seem to play a role, affecting airway function and inflammation. Postmenopausal women who are on hormone replacement therapy (HRT) - - estrogen with or without progesterone - - are 50 percent more likely than those not on H R T to develop asthma (AmericanJournal of
Respiratory Critical CareMedicine, 1995;152:1183 -1188). Smaller airway size, a trait specific to females, may also account for increased asthma severity in older women. Smaller airways may become blocked more easily and to a greater extent. Challenges Diagnosing
in Asthma
Asthma is often underdiagnosed or misdiagnosed in seniors. This may be partially due to the continuing misperception that the condition is uncommon in this age group. Also, coexisting medical conditions, which are common in older people, can make asthma more difficult to diagnose and treat. Symptoms from other subscribe
call
1.800.527.3284
7
medical conditions can mask or hide the existence of asthma. The symptoms of some diseases actually mimic asthma. Add the possibility of shared or overlapping symptoms, and the process can be further muddled. For example, it is sometimes difficult t o differentiate asthma from chronic obstructive pulmonary disease (COPD). Wheezing, coughing and mucus production are common symptoms of both conditions. COPD, a general term that includes emphysema and chronic bronchitis, is typically caused by a lifetime of smoking. In cases where there are coexisting medical conditions, it is generally recommended that the person see an asthma specialist. Diagnosing asthma in older people can be a challenge - - much like solving a puzzle. Medical examination and tests can provide clues to piecing together that puzzle. These procedures include a thorough medical history, physical examination, a study of nasal and mucus secretions, a chest xray, lung function tests and allergy tests, when indicated. Sometimes, doctors must work backwards by ruling out other conditions first. Evaluating a person's response to a trial asthma therapy can also be part of the diagnostic process. Treatment
Once it is determined that a person has asthma, medical management of seniors is similar to that for all asthmatics. This includes avoidance of allergens and irritants that can trigger symptoms, therapy with medications and sometimes immunotherapy (or "allergy shots"). A personalized asthma action plan helps seniors selfmanage their condition and tells them when to seek emergency help. With seniors, however, the same diseases that interfered with diagnosing asthma may complicate treatment. Warren V. Filley, MD, a practicing allergist and clinical associate professor of medicine at The University of Oklahoma Health 8
ASTHMA MAGAZINE
to
subscribe
Sciences Center, says the biggest challenge he encounters treating older asthmatics is the tendency for multiple disease states to require multiple medications. "The potential for side effects and drug interactions is often enormous." Unfortunately, some medications taken to treat a coexisting illnesses can actually cause or worsen asthma symptoms. For example, many older people take medicines called beta blockers to treat high blood pressure and other heart conditions. But these medications can increase asthma symptoms. Aspirin, often taken to relieve or control symptoms of arthritis, can be a potent asthma trigger for those who are sensitive to it. Conversely, some asthma medications can complicate other medical conditions. Older asthma patients, therefore, should be monitored closely during asthma treatment. It is important to ensure that prescribed medications are safe and effective. Patients should be monitored for potential drug interactions or side effects. There needs to be especially good communication between seniors with asthma and their health care provider. It is important for patients to inform their health care provider of all the medications they are taking for various conditions. call
1.800.527.3284
Also, Dr. Filley recommends that patients write down questions they have concerning their health. They should also make a note of symptoms they have noticed over the course of treatment - - whether or not they think they are asthma-related. This should be brought to the next appointment with their health care provider and discussed thoroughly. Seniors Do Get
With Asthma Better
The silver lining of late-onset asthma is that it is treatable and usually reversible. It may not be quite as reversible as it is in a younger counterpart, Dr. Filley says, but older people can still get significant relief from symptoms and often improved lung function once proper treatment is started. Clearly, the key to effective asthma treatment in all age groups is a prompt diagnosis and aggressive treatment beginning as early as possible in the disease process.
Teresa Thorn is a freelance writer living in Oklahoma City, Oklahoma. She specializes in medical and healthrelated topics. Look for part II of this series on seniors with asthma in the July/August issue of Asthma Magazine.