Improving outcomes in elderly patients with asthma

Although often regarded as a disease of childhood, asthma is common in elde rly 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 r esponse to treatment. The nonspecific presentation of asthma in elderly adu lts means that the diagnosis of asthma is difficult to make. In addition, r esearch suggests that physicians are reluctant to use spirometry and measur ement of reversibility when investigating respiratory symptoms in old peopl e. 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 wi th bronchodilators and corticosteroids. Treatment guidelines for the management of asthma in children and younger a dults may need to be adapted when applied to older patients. Reduced percep tion of bronchoconstriction may lead to underuse of bronchodilators prescri bed 'as required'. The bronchodilator response to beta(2)-agonists is atten uated as part of the normal aging process, and other groups of bronchodilat or medications should be considered. Inhaler technique can be a particular problem in elderly patients with asthma, requiring careful choice of inhale r device. However, the frequent presence of multiple pathology and multiple medication in this age group enhances the risk of adverse effects from ora l preparations, and so the inhaled route should be preferred wherever possi ble. Underestimation of the severity of an acute exacerbation of asthma by both patient and doctor has been suggested as a contributory factor to poor outc ome in older people. Since the cardiovascular responses to hypoxia and bron choconstriction tend to diminish with increasing age, objective measures of asthma severity (peak flow monitoring and blood gas estimation) are essent ial in this age group.