Asthma in older adults

Tricky to diagnose

Many people think of asthma as a breathing problem affecting kids. However, more than half of all those with asthma are adults. In addition, the risk of developing asthma for the first time is just as great in adults over age 65 as it is in just about any other age group except early childhood.

Fortunately, by working in partnership with your doctor, asthma is usually a very manageable disease at any age. Most people respond well to appropriate treatment, allowing them to lead active lives.

Are LABAs dangerous?

If you use a long-acting beta-2 agonist (LABA) for long-term asthma control, you may have seen reports — or even the warning on your prescription — highlighting the potential danger of increased fatal asthma attacks among those using this class of drugs.

However, Mayo Clinic asthma experts believe that LABAs are an effective medication for many with both asthma and chronic obstructive pulmonary disease (COPD). When used properly, they're as safe as alternative treatments, and more effective. Proper use involves two key elements:

·         For asthma, LABAs should always be taken along with inhaled corticosteroids.

·         The LABA salmeterol shouldn't be used alone as a "rescue" medication for relief of an asthma attack. The LABA formoterol is also long acting, but has a faster onset of action. Some specialists feel it can be useful for quick relief of symptoms.

Airway obstruction
Asthma occurs when airways (bronchial tubes) in the lungs become constricted and inflamed. Constriction occurs as muscles around the bronchial tubes tighten. Inflammation causes bronchial tube swelling, further reducing bronchial tube space, and extra mucus production blocks your airways. The combination of smooth muscle constriction (bronchospasm), inflammatory bronchial thickening and mucus obstruction all contribute to obstructed airflow.

Classic signs and symptoms of asthma include wheezing, coughing, shortness of breath and chest tightness. However, older adults may not have all these classic signs and symptoms. There may be only one symptom or several, and the signs and symptoms can be mild or severe and can occur most of the time or may come and go. In older adults, coughing is a common sign, and it can be the only sign.

There are many potential triggers for asthma attacks. In adults who develop asthma late in life, most experience their first symptoms in conjunction with — or after — an upper respiratory viral infection. Additional triggers of initial or ongoing asthma attacks may include airborne allergens, exercise or gastroesophageal reflux disease (GERD), which can occur "silently" without causing heartburn.

Other triggers include strong emotions, preservatives called sulfites, and certain medications, including aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) and beta blockers.

Is it asthma?

Diagnosis of asthma generally starts with a physical examination, and a discussion of your symptoms and what seems to trigger them. Further evaluation may include breathing tests, a chest X-ray, blood tests or allergy tests. More specific asthma testing may include:

·         Lung function test — At your doctor's office, you may breathe in and out through a device called a spirometer to measure lung capacity. If your lung capacity is below normal for your age, it may be a sign of narrowed bronchial passages.

·         Bronchodilator test — If your lung function is found to be below normal, you may be asked to inhale a drug (bronchodilator) to open your airways. If your lung function improves, you may have asthma.

·         Methacholine (meth-uh-KO-lene) challenge test — If a diagnosis isn't clear, you may be asked to inhale a dose of methacholine. If you have asthma, the drug typically causes a temporary, measurable decrease in airway function.

·         Nitric oxide test — Elevated nitric oxide levels in exhaled air may indicate airway inflammation. Taking an inhaled corticosteroid may reduce these levels if you have asthma.

·         Sputum eosinophils — Studying a sputum specimen for a particular type of cell called an eosinophil can be helpful in an initial diagnosis of asthma. However, due to issues with the technique, the test isn't widely used.

Managing asthma involves treating, limiting or avoiding triggers — and taking medications properly.

Work closely with your doctor to determine which medication or combinations of medications are best for you. Drug choice and dosages vary depending on asthma severity and how well your asthma is controlled. As you gain control of your asthma, your doctor may be able to reduce or "step down" the amount of medicine you need.

Asthma action plan

Work with your doctor to develop a plan — often called an asthma action plan — for managing your asthma. Learn how to monitor your lung function at home, and make sure you know what to do if your lung function decreases.

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