Cookie Notice

This site uses cookies. By continuing to browse this site, you are agreeing to our use of cookies. Review our cookies information for more details.

OK
skip to main content

Asthma Among Older Adults

Asthma and the ElderlyAsthma Diagnosis and Management of Comorbidities
Asthma is a long-term disease that causes swelling and tightening of the airways in the lungs. Common symptoms include shortness of breath, coughing, chest tightness, wheezing and difficulty exercising. In the United States, about 1 in 12 people have asthma. Although 1 in 10 older adults also have asthma, it often goes undiagnosed or unnoticed in half of them because the symptoms can be mistaken for other issues such as heart problems or COPD.

Asthma can be harder to treat in older adults because they often have other health problems like sleep apnea (trouble breathing during sleep), acid reflux (heartburn), heart disease or other lung issues. These conditions can have symptoms similar to asthma, making it difficult to tell them apart.

If a doctor thinks you might have asthma, they can check with a lung function test called spirometry. Spirometry measures how well your lungs move air in and out, which helps to confirm if you have asthma and how serious it is. Another test, called fractional exhaled nitric oxide (FeNO), can measure inflammation in your airways, similar to how a smoke detector senses smoke. This test can help doctors decide which asthma treatments might work best for you.

Asthma in older adults can be grouped into different types, based on when it started, how long it has lasted and what triggers it. These types include:

• Long-standing asthma: Starts in childhood and is often linked with allergies, like eczema or hay fever.
•Adult-onset asthma: Starts in middle age and usually isn’t linked to allergies.

It’s very important to talk openly with your doctor about managing asthma. As we age, it can be harder to remember medication details, and asthma treatment can be confusing with different inhalers, schedules and purposes. Knowing how to use your medication correctly, like with proper inhaler technique, and overcoming any challenges to getting healthcare are key to controlling asthma effectively.

Exercise-Induced Bronchoconstriction among Older Adults
Exercise-induced bronchoconstriction (EIB), or airway tightening, causes asthma symptoms during or after exercise. EIB can be more common, more intense and last longer in older adults than in teenagers. Sometimes, people think they are just out of shape or having heart problems when they feel shortness of breath or chest discomfort during exercise.

To help prevent EIB, people with asthma should warm up before exercising and use their rescue inhaler (usually albuterol) ahead of time. There is no evidence that one type of exercise is better than another for improving asthma health. You don’t need to avoid exercise if you have EIB. Using albuterol and staying active regularly can help improve asthma control and lung function, no matter the type of exercise. Physical activity can help improve asthma control and lung function regardless of the type.

Special Considerations of Pharmacotherapy in Older Adults
The goal of asthma treatment in older adults is the same as for younger people: to control symptoms, improve quality of life and reduce the risk of asthma attacks and hospital visits. Treatment mainly involves using different types of inhalers:

• Corticosteroid inhalers: Reduce swelling in the airways.
• Short or long-acting beta-2 receptor agonists and long-acting muscarinic antagonists: Help open the airways.

For moderate to severe asthma, doctors may suggest a combination inhaler that has both a corticosteroid and a long-acting beta-2 agonist (like formoterol) to use as a daily inhaler and as a rescue inhaler when needed. This approach, called SMART (single maintenance and reliever therapy), has been shown to be more effective than using a rescue inhaler alone.

Some older adults may have trouble using inhalers due to difficulty taking deep breaths or limited hand coordination, but there are various inhalers and nebulizers available to help. It’s important to talk to your doctor about finding the right and affordable option for you.

It’s also recommended that people with asthma quit smoking or vaping, get appropriate vaccines and avoid known asthma triggers. Pulmonary rehabilitation, a program to strengthen breathing, can also help older adults manage asthma and improve quality of life.

For older patients who have frequent asthma flare-ups, use steroids often or have symptoms that don’t improve with regular inhalers, a stronger type of medication called biologics may help. Biologics are injections that target specific immune triggers for asthma, helping to control symptoms and prevent future flare-ups. While older adults need to be careful about medication side effects, biologics for asthma are generally safe with close monitoring.

Shared Decision Making and Goals of Care
A key part of caring for older adults with asthma is making sure that your personal needs, values and preferences are respected in decisions with your doctor. This includes understanding your medications and test results, knowing how to use your inhalers and discussing any concerns you or your family have. It’s also important to talk about your treatment goals.

As people with asthma get older, it may be harder to achieve normal lung function with medications. Planning for future care is essential to ensure you receive the right support. This can include choosing someone to help make medical decisions for you if needed and discussing which lifesaving treatments you would want in an asthma emergency. For example, you might decide if you would want a breathing tube if your lung function worsens.

Having conversations about whether to focus on prolonging life or prioritizing quality of life can be very important for older adults with asthma. This helps ensure that your wishes are respected.

Find out more about asthma.

Resources:
1. Dunn RM, Busse PJ, Wechsler ME. Asthma in the elderly and late-onset adult asthma. Allergy. 2018;73(2):284.
2. Enright PL, McClelland RL, Newman AB, Gottlieb DJ, Lebowitz MD. Underdiagnosis and undertreatment of asthma in the elderly. Chest. 1999;116(3):603–13.
3. Figueiredo RG, Arata V, de Bessa J, Cruz AA. Challenges in the management of asthma in older adults. Curr Treat Options Allergy. 2023;10:64–81.
4. Ji H, Tan LD, Hafzalla GW, Nguyen N, Alismail A. Navigating biologic therapies in elderly asthma. Respir Med. 2024;227:107655.
5. Jaakkola JJK, Aalto SAM, Hernberg S, Kiihamäki SP, Jaakkola MS. Regular exercise improves asthma control in adults: A randomized controlled trial. Sci Rep. 2019;9(1):12088.
6. Khosa JK, Louie S, Lobo Moreno P, Abramov D, Rogstad DK, Alismail A, et al. Asthma care in the elderly: Practical guidance and challenges for clinical management - A framework of 5 “Ps.” J Asthma Allergy. 2023;16:33–43.
7. Nanda A, Baptist AP, Divekar R, Parikh N, Seggev JS, Yusin JS, et al. Asthma in the older adult. J Asthma. 2020;57(3):241-252.
8. National Center for Health Statistics. (2023). 2022 NHIS Adult Summary Health Statistics. U.S. Department of Health and Human Services. Available from: https://data.cdc.gov/d/25m4-6qqq
9. Welch R, Lardenoye M, Kolbe J, Ellyett K. Exercise induced bronchodilation: a phenomenon more common, greater magnitude and more prolonged in older adults than in adolescents. J Asthma. 2023;60(5):1016-1023.
10. Chupp G, et al. Asthma control in the United States. Ann Allergy Asthma Immunol. 2024;133(3):302-309.

The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

11/12/2024