Asthma also affects seniors

Asthma is often considered a disease of young people, even children. It is true that half of the cases are observed before ten years of age and that the crises often disappear in adolescence. However, the disease can persist throughout life or appear in adulthood.

What are the particularities of asthma in the elderly?

Depending on its age and severity,  asthma symptoms vary from person to person . Generally, one or more signs may appear:

• respiratory  discomfort  : due to the narrowing of the bronchi which limits the passage of air. Breathing then becomes more difficult, especially on exhalation.
• a  feeling of suffocation, tightness, weight on the chest
• a  dry cough  : certain factors can irritate the mucous membrane that lines the inside of the bronchi
• wheezing   : the caliber of the bronchi being narrowed, the passage of air produces a whistle at the time of expiration .

In the elderly, a distinction must be made between two types of asthma:

• "Aged" asthma (linked to the natural evolution of childhood or adolescent asthma)
• Late-onset asthma also called  "de novo asthma" (linked to a  poorly treated respiratory infection or  natural aging of the respiratory system )

These late forms are important to be aware of, on the one hand because they are often difficult to diagnose and on the other hand because they can lead to disabling symptoms and serious attacks . Indeed, these forms of asthma frequently present as asthma with continuous dyspnea , difficult to control  and sometimes corticosteroid -dependent .

Asthma in seniors in numbers

In France, asthma affects  6 to 7% of the elderly .  Women are the most affected,  after 50 years . Studies even show a peak in frequency in women  at the time of menopause .

According to a survey by the Center de Recherche d'Etude et de Documentation en Economie de la Santé, the older the person, the greater the risk of severe asthma . This form of asthma is characterized by permanent respiratory discomfort and frequent attacks, limiting activity. 1/4 of asthmatics aged 60 and over have severe persistent asthma .

Other indications are given by the network of general practitioners Sentinels of the National Institute of Health and Medical Research (Inserm), who report since 1997 all the asthmatic patients they hospitalize. Of the 15,000 patients hospitalized on average each year:

• 30% are under 15 years old
• 21% between 15 and 59 years old
• 32% between 60 and 74 years old
• and 17% over 75 years old .

Diagnosis of asthma in the elderly

Asthma is the most common  chronic disease in children, but not so in the elderly. Indeed, the causes of respiratory problems are very numerous. In addition, the symptoms of asthma, are the same as other diseases (often a cough with sputum coming from the lungs).

Thus, during a consultation, the health professional does not think of asthma immediately, he may  interpret these symptoms as consequences of another disease or complications , such as chronic bronchitis or heart failure , for example.

Heart  and lung disease , common in the elderly and smokers, can mimic asthma symptoms. Performing a therapeutic test can be useful to confirm the diagnosis.

All this tends to  delay the diagnosis of the disease in seniors .

Faced with the existence of respiratory discomfort, certain pathologies must be considered in the elderly:

• cardiac pseudo-asthma which is often accompanied by genuine bronchial hyperreactivity to methacholine 
• gastroesophageal reflux _
• chronic  cough related to an attack of the upper respiratory tract (chronic sinusitis, posterior rhinorrhea, etc.).

• What treatments for asthma in seniors?

  The  treatment of asthma is similar to that applied to younger patients. 

  Two types of treatment can be distinguished:

  • Emergency treatments  that relieve the crisis. They open the narrowed bronchi, hence their name  "bronchodilators" . There are different types. Most often inhaled, they can also be prescribed orally or by injection;
  • Fundamental treatments for asthma . A distinction is made between bronchial anti-allergics and anti-inflammatories.

  However, some particularities deserve to be underlined. With age, conditions such as osteoarthritis, coronary heart disease or glaucoma, become very common and often lead to heavy prescriptions .