Asthma: Not Just for Children

Even though it is commonly associated with young people, asthma is a disease that also affects older adults. Up to 10 percent of older adults may have the disease.

Asthma in older adults presents some special concerns because the normal effects of aging can make asthma harder to diagnose. Beginning at age 40, your lung capacity and functioning start to decrease. Both of these are also affected by other medical problems such as heart failure, which can cause wheezing, and chronic obstructive pulmonary disease (COPD), which in turn can cause a chronic cough.

Seniors can be more susceptible to asthma because they often take medications that can cause allergic reactions, which may trigger asthmatic attacks, according to the National Heart, Lung and Blood Institute (NHLBI). According to American Academy of Allergy, Asthma and Immunology (AAAAI), older people who have asthma tend to be former smokers or have a history of allergic disease

Overlooking asthma

Asthma affects almost 20 percent of children and is often seen as a childhood disorder, says Marianne Frieri, M.D., an immunologist and spokeswoman for the AAAAI. This is one reason that asthma is often overlooked in older adults.

In seniors, new cases of asthma can also go unrecognized for several other reasons. Older people may have symptoms that are not typical of asthma; for example, a nighttime cough may be the only symptom. Seniors or their health care providers may assume their symptoms are a result of their age, smoking, heart trouble or air pollution exposure. Heart and blood vessel diseases can coexist with asthma and can have similar symptoms. Difficulties in diagnosis can also occur if the person with asthma is confused or has physical disabilities.

Other conditions vs. asthma

• Asthma and COPD. Both of these conditions can cause shortness of breath, coughing and wheezing. The difference comes in the timing of these symptoms. A person with asthma is more likely to have them periodically, at night or after being around allergens. A person with COPD is more likely to have a cough in the morning and then symptoms throughout the day. Asthma can be treated with anti-inflammatory medications; COPD, although it causes some inflammation, does not respond well to these drugs, the AAAAI says.

• Asthma and heart disease. Asthma symptoms also resemble those of heart disease. A person with either condition may have difficult sleeping through the night and may notice ankle swelling. Chest tightness and shortness of breath may indicate either heart problems or asthma. A person who has both asthma and heart disease may have problems taking medications for treatment: drugs that help control asthma may pose heart risks, and drugs for heart conditions may make asthma symptoms worse.

• Asthma and chest pain. People with asthma also often have gastroesophageal reflux disease (GERD), the symptoms of which include chest pain. Chest pain can also be a sign of heart disease. GERD can also trigger asthma, cause chronic coughing and lead to a chemical pneumonia. "One thought behind GERD-inducing asthma is that the stomach acid refluxes up into the throat and upper airway, thereby triggering narrowing of the airways and inflammation characteristic of asthma," says John W. Georgitis, an allergist in Winston-Salem, N.C. "With aggressive treatment for GERD, the asthma symptoms are easier to control."

Symptoms of asthma

If you have any of these symptoms, see your doctor:

• Coughing, especially at night

• Wheezing

• Chest tightness

• Shortness of breath

• Breathing faster than normal

• Getting out of breath easily

• Feeling tired or weak

Asthma triggers in seniors

Allergic reactions are often responsible for triggering asthma symptoms. Common allergens that can trigger asthma include cat dander, pollen, dust mites and cockroaches. If your asthma is triggered by any of these, try to limit your exposure.

Medications are a more common cause of asthma attacks in older people. "That strong beta-blocker eye drop that you take for glaucoma might enhance your asthma response," says Richard W. Honsinger, Jr., M.D., a New Mexico allergist. "A beta-blocker or an angiotensin converting enzyme (ACE) inhibitor that you take for blood pressure can provoke a cough." Beta-blockers are frequently prescribed for heart problems and other conditions. Traditionally, people with asthma have been told to avoid these; however, several studies have shown no significant worsening of asthma with use of beta 1-selective blockers such as atenolol.

Even over-the-counter (OTC) medications can cause or trigger asthma. For example, adults can have aspirin-induced asthma, in which small amounts (15 to 30 mg) of aspirin can bring on acute wheezing, coughing, shortness of breath and/or chest tightness. The average age for the onset of aspirin-induced asthma is 46, says Dr. Honsinger. The aspirin reaction can also be caused by other nonsteroidal anti-inflammatory drugs like ibuprofen. A study published in the May 2005 American Journal of Respiratory and Critical Care Medicine reported that daily use of  acetaminophen may be associated with a greater prevalence of asthma and COPD. Acetaminophen is a pain reliever found in many OTC cold and flu medicines.

Medication triggers

Other medications can also provoke a reaction, so be sure to inform your physician of all medications you are currently taking, both prescription and non-prescription.

Respiratory infections are another common trigger that older adults should consider. "Those slobbery kisses from a cute grandchild can be laden with germs," Dr. Honsinger says. "Some of those can't be prevented, but at least you can take a flu shot every fall."

Be sure to get an annual flu shot, as well as a pneumococcal pneumonia vaccination if you are older than 65. If you had a pneumonia vaccination before age 65, you may need a booster.

Being aware of your asthma triggers can help control your asthma. Your doctor can help you explore your asthma triggers, avoid them and sometimes treat you before your exposure. "Referral to an asthma specialist, such as an allergist/immunologist or pulmonary physician can help document the causes of your asthma, because they are experts in identifying triggers by history, examination, allergy testing and pulmonary function studies," says Dr. Georgitis.

Taking care after your diagnosis

If your health care provider diagnoses asthma, keep in mind that your treatment will be different from that of a younger person, particularly if you have other health conditions. As part of your treatment plan, you should learn to recognize an asthma attack and know how to deal with it.

"Most asthma attacks start slowly," says Dr. Panettieri. "You can learn to tell when one is coming if you keep track of the symptoms you have and how bad they are. If you respond early to the first signs your asthma is getting worse, you can prevent serious asthma episodes."

Before you begin any asthma treatment, be sure your doctor knows about all the medications you take because asthma drugs can have adverse side effects when taken with other medications.

"If you must take inhaled asthma medicine, check with your doctor to make sure you're taking it right," Dr. Panettieri says.  "Health problems such as arthritis may make it difficult to use inhalers correctly."