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What works best to control asthma in older adults? It isn't only a disease that affects children; older people can suffer from asthma, too.

More than 20 million Americans have asthma, a disease that causes blocked airways leading to shortness of breath, wheezing, and coughing. And approximately 10 percent of people with the disease are older than 65, according to the American Lung Association.

It is more common for older adults to develop asthma if they had it as a child, but the disease also can be diagnosed for the first time in adulthood.

"Given the right circumstances, an adult will develop full-blown asthma for the first time later in life," says pulmonologist Neil Schachter, MD, Maurice Hexter Professor of Pulmonary Medicine and medical director of the Respiratory Care Department at Mount Sinai Medical Center. "However, it is more common to develop asthma in childhood, go into remission as a teenager, and then develop asthma again later in life."

Airway irritation present. What causes older adults to develop asthma? Although they can develop allergic asthma from substances such as pollen and cats, just as younger people do, they are more likely to develop asthma due to irritation of their airways from environmental exposures such as air pollution or cigarette smoke, Dr. Schachter explains.


"In children, asthma is primarily driven by allergens, while in adults, it's more commonly driven by irritants," he says.

Pulmonologist Nicholas J. Kenyon, MD, associate professor of medicine at University of California, Davis, in Sacramento, says that viruses such as the common cold may trigger asthma in an older adult.

"It usually happens when the person has a series of colds, does not fully recover, and [he or she] finally gets diagnosed with asthma," he notes. "The person may have significant shortness of breath, chest heaviness, and wheezing. At night, they have a cough that wakes them up."

It's important to note that other conditions like heart failure, reflux esophagitis, vocal cord dysfunction, and blood clots in the lungs can all present with symptoms similar to adult-onset asthma.

Appropriate treatment. Because other respiratory diseases such as chronic obstructive pulmonary disease (COPD) mimic asthma, it may be diffi cult to diagnose. But getting an accurate diagnosis is important, because treatments may differ, says Dr. Kenyon. For example, with asthma, the primary treatment is an inhaled steroid such as flunisolide (Aerobid), but with COPD, the patient is usually placed on a bronchodilator, such as albuterol (Proventil), first.

Appropriate medications are crucial to treating asthma successfully. Both Drs. Schachter and Kenyon refer to new asthma guidelines for doctors from the National Heart Lung and Blood Institute, which state that older adults with asthma need special considerations, as follows:

* If someone has COPD or chronic bronchitis and has symptoms of asthma, he or she may be tried on a corticosteroid such as prednisone. If asthma symptoms improve, then the physician knows the patient has asthma as well.

* Asthma medications may aggravate other medical conditions. For example, albuterol (Proventil), which is used to help wheezing, may cause an irregular heartbeat (arrhythmia).

* Patients must be taught to take their medications correctly, because proper use of inhalers is essential to treating asthma successfully.

Schachter says special delivery systems such as aerosol chambers are available for people who have diffi culty using regular metered-dose inhalers because of arthritis or cognitive diffi culties. The chamber allows the person to spray the medication into one end, and then breathe in the mist normally through a mouthpiece at the other end.

Two main types of medications are used to treat asthma: long-term control medications, which help keep the disease under control, and quick-relief medications, which are used to treat flare-ups. Long-term control medications include corticosteroids and long-acting beta2-agonists such as salmeterol (Serevent). Quick-relief medications include anticholinergics such as ipratropium (Atrovent) or short-acting beta2-agonists such as albuterol.

"With good medical supervision and management, the majority of [older] asthmatics can lead relatively normal lives," says Dr. Schachter.

How to Use an Inhaler Properly

1. Remove the cap and shake the inhaler before using.

2. Breathe out completely.

3. Hold the inhaler about two inches away from your mouth.

4. Start breathing in slowly, through your mouth, and then press down on the inhaler.

5. Continue to breathe in, as deeply as you can.

6. If possible, hold your breath for 10 seconds before exhaling.

7. Repeat as directed.


To improve asthma symptoms:

* If you smoke, quit; avoid secondhand smoke.

* When pollen counts are high, stay indoors as much as possible and keep windows closed.

* Cover your mattress and pillow with slipcovers; wash blankets weekly in hot water.

* Write an "asthma medication care plan" with your doctor.

* Always tell your doctor about any new medications you are taking for other conditions.
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Publication:Focus on Healthy Aging
Article Type:Clinical report
Geographic Code:1USA
Date:Dec 1, 2007
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