Proper management can help you function with asthma: identifying triggers and using the right medications are vital to controlling symptoms, breathing freely and living better with this common condition.
Asthma may be more problematic in older adults. Seniors are more likely to be taking medications that interact with asthma treatments or worsen asthma symptoms. And, asthma may go undiagnosed because it's easily mistaken for other conditions that occur more frequently with age.
"Asthma is common among people in their 60s and 70s, and it can be associated with serious health problems," says David Lang, MD, head of Allergy and Immunology and co-director of the Asthma Center at Cleveland Clinic's Respiratory Institute. "The good news is that although there's no cure, with proper management asthma can be controlled in the great majority of patients."
Asthma affects the bronchial tubes, or airways, of the lungs. During normal breathing, the smooth muscle surrounding the bronchial tubes remains relaxed, allowing air to pass freely. During an asthma attack, the muscle constricts and narrow the airways, the lining of the bronchial tubes becomes swollen or inflamed, and the cells lining the airways generate more mucus. These factors cause the wheezing, chest tightness, coughing and shortness of breath associated with asthma.
Identifying asthma in older patients can be tricky, because its symptoms may mimic those of other conditions. For instance, chronic coughing may be the only symptom for some older asthmatics, but it's also a sign of post-nasal drainage and gastroesophageal reflux disease.
Shortness of breath, chest discomfort, wheezing and coughing also may be manifestations of other common age-related disorders, such as emphysema or a heart condition such as heart failure.
"A historical feature that characterizes asthma as opposed to emphysema or heart disease is that people with the latter two conditions are more likely to describe a sensation of shortness of breath, whereas asthmatics are more likely to describe chest tightness," Dr. Lang explains.
GETTING THE RIGHT DIAGNOSIS
Distinguishing asthma from other conditions requires a thorough evaluation, including a review of your medical history and a physical exam. Document your symptoms, and tell your doctor about any family history of asthma or other lung problems.
Your physician will test your lung function, and you may undergo allergy tests. "In a substantial proportion of older adults, allergen exposure is one of the factors that is relevant for ongoing asthma symptoms and should be addressed," Dr. Lang says.
Share with your doctor a list of all your medications. Multiple medicines for other conditions may interact with those used to treat asthma. Furthermore, drugs used to treat heart problems and high blood pressure (e.g. beta blockers) may worsen asthma symptoms. A subgroup of asthmatics who also have chronic sinusitis may have serious respiratory reactions from aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.
YOUR TREATMENT PROGRAM
Your doctor will work with you to create a plan to treat your asthma. Part of that plan includes identifying what causes your symptoms and how to avoid these triggers. "Through a program of avoidance measures, combined with regular medicine use, asthma can be controlled in most patients," Dr. Lang says.
Asthma is classified into four categories:
* Mild intermittent asthma: Symptoms occur less than twice a week, and nighttime symptoms happen less than twice a month; lung function is 80 percent or greater than predicted.
* Mild persistent asthma: Symptoms occur more than twice a week but not every day; lung function is 80 percent or greater than predicted.
* Moderate persistent asthma: Symptoms occur daily; episodes occur more than once a week and affect activity; lung function is 60-80 percent of predicted.
* Severe persistent asthma: Symptoms occur constantly, with frequent flare-ups night and day; activity is limited; lung function is less than 60 percent of predicted.
For intermittent asthma, reliever medications such as short-acting beta agonists (albuterol and pirbuterol are examples) may be prescribed. These inhaled drugs rapidly open airways and quickly relieve symptoms.
Persistent asthma requires a controller medicine. Inhaled corticosteroid drugs, which reduce inflammation and mucus production and prevent symptoms, are a first-line therapy for people with persistent asthma, Dr. Lang says. Oral corticosteroids may be used to control severe asthma flare-ups.
Several drugs--including long-acting beta agonists (LABAs) and antileukotrienes--may be used along with inhaled corticosteroids. Several inhalers combine inhaled steroids with LABAs.
In February, the U.S. Food and Drug Administration issued an advisory that LABAs should not be used alone in treating asthma, but should be used only in combination with a controller medication, such as an inhaled corticosteroid. The advisory came after studies showed that use of LABAs was associated with a greater risk of severe worsening of symptoms, hospitalizations and death in some asthma patients.
Although doctors must weigh the risks and benefits of using LABAs in older patients, Dr. Lang says the drugs are still a valuable part of asthma treatment. "When these drugs are prescribed appropriately for patients with moderate-to-severe persistent asthma, they have therapeutic utility, and patients will experience superior outcomes," he says.
A PLAN FOR YOU
Your action plan should detail how and when to use asthma medications, what to do if your asthma worsens and when to seek emergency care.
Most importantly, it should be tailored to your needs. For example, high cumulative doses of corticosteroids may be associated with greater risk of osteoporosis and may not be preferable if you have a history of fractures. Dr. Lang advises, "If you're an older adult and you have asthma, you should seek out an asthma care provider who can assist you with identifying the triggers for your asthma, develop a personalized plan of avoidance measures and a management plan that includes medications that are effective and well tolerated so that your asthma can be controlled."
WHAT YOU CAN DO
* If you're obese, work with your doctor to develop a diet and exercise program to lose weight. Some research suggests that obesity may raise the risk and severity of asthma.
* Seek an evaluation if you experience shortness of breath, coughing, wheezing or chest tightness.
* Identify and remove or limit your exposure to relevant asthma triggers--such as pet dander, dust mites, mold spores and tobacco smoke.
* Use your asthma medications exactly as your physician advises. Tell your doctor if you notice changes in how your medicines control your asthma.
Examples of common asthma medicines
Long-acting beta agonists
Reliever (rescue) medications
Short-acting beta agonists
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|Publication:||Men's Health Advisor|
|Date:||Jul 1, 2010|
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