Asthma in the elderly brings a new set of issues that have to be tackled during treatment.
While most people know about the use of inhalers, steroid inhalers, regularity of inhalers, relievers and preventers when dealing with asthma, there is one segment of the population that may not have heard of these: the elderly people. The other aspect in this is how the elderly feel about using such measures.
It was brought home to me during screening camps that many people in their eighties who suffered from asthma had not heard of or seen inhalers. For such people, an asthma attack means a visit to a doctor's office for an injection of deriphyllin or a steroid. No nebulisers, inhalers or counselling.
A doctor treating an elderly person suffering from asthma needs to be aware of other health issues like diabetes, hypertension, heart disease or arthritis. Drugs like aspirin, beta blockers and pain killers can worsen asthma. The other problem is that drugs used to treat asthma can interfere with other medications.
Given that an older person's response to drugs is not very quick, the prescription for asthma should not be changed frequently. Over-usage can worsen co-existing conditions. For example use of oral steroids for prolonged periods can worsen diabetes or unmask latent diabetes. An older asthma patient with increasing breathlessness should be investigated for cardiac or renal conditions instead of routinely stepping up dosage.
It is also important to differentiate between COPD and asthma. COPD occurs in patients with a history of smoking and has bad prognosis in contrast to asthma, which can be treated. Pulmonary function tests will be difficult in some patients as they may be without teeth. A medical history and a clinical examination with arterial blood gases or measurement of oxygen saturation will be better.
Coexisting problems like hyperacidity, gastro-oesophageal reflux, depression and respiratory infections may hinder response to therapy and also increase the symptoms.
Some eye drops containing non-selective beta blocking drugs, even in very small doses, can trigger a severe attack. The patient must inform the eye-specialist about his asthma medication.
Also remember that allergens can trigger asthma attacks. Since most elderly people do not venture out too often, indoor allergens like smoking, mites, dust, plants, curtains, cockroaches and pets will be the main culprits.
The main issue in treatment is to get the elderly used to inhalers. It takes them a while to master the technique. The most important thing to remember is that long-term steroid inhalers tend to accelerate symptoms of osteoporosis. As acute attacks can be life-threatening, there should be no delay in approaching a physician.