Skin disorders are common in elderly people. Systemic diseases promote the development of dermatological conditions. A comprehensive approach to health problems in elderly subjects requires knowledge of dermatology.
in the elderly, a division of patients into two groups shall be considered. The first group shall include patients with a longstanding asthma, whose symptoms occurred before the age of 65, and the second group shall include patients, in whom the symptoms occurred after the age of 65. It is worth mentioning a historical study by Lee and Stretton [8] on patients with late-onset (after the age of 65), severe bronchial asthma. Attention should, however, be paid to the fact that the study involved a small, 15-person group, mostly smokers complaining of a long-standing productive cough. In the study by Quadrelli et al. [9], the elderly with diagnosed late-onset asthma had similar intensity of disease symptoms to the young patients. Patients with a long-standing disease, contrary to the late-onset asthma patients, had a shorter symptom-free period, increased number of hospitalizations and emergency medical interventions during a year, as well as lower values of ventilation parameters. Braman et al. [10] observed that among elderly asthma patients, subjects with a long-standing disease have considerably impaired lung function, which results in symptoms similar to the ones observed in a chronic obstructive pulmonary disease (COPD). Contrary to the aforementioned researchers, Burrows et al. [11] did not found relations between the disease duration and its severity. Those authors showed that the course of bronchial asthma in the elderly patients, despite considerable ventilation impairment, in long-term follow-up is not characterized by a rapid deterioration. The observed discrepancies show that elderly patients diagnosed with bronchial asthma are a composite group. Additional difficulties occurring during attempts to characterize bronchial asthma in elderly patients result from the fact that the changes due to advanced age of studied persons overlap with the disease manifestations.
A b s t r a c tIntroduction: The reversibility test measures an increase in ventilation parameters after the administration of 400 µg of a short-acting β-agonist (SABA). It is worth noting that a typical dosage, applied as a rescue medicine for bronchospastic dyspnoea, is significantly less, i.e., 100-200 µg. Aim: To assess the effects of inhaled 400 µg fenoterol (in the bronchodilator reversibility test) on the heart rate and the development of tachyarrhythmias in subjects aged 65 and above. Material and methods: A total of 53 subjects (45 women) aged 77; 68-82 (median; interquartile range) in stable clinical condition were included in the study. Data including medical history, physical examinations, blood biochemistry, chest X-ray, 12-lead electrocardiogram, 24-hour Holter ECG monitoring, bronchodilator test, and echocardiography were obtained. During the Holter ECG monitoring, the bronchodilator test using 400 µg fenoterol (Berotec pMDI) was performed. Results: A slight but statistically significant (p = 0.02) increase in heart rate from 71 to 75 per min (median) was noted after the administration of fenoterol. No statistically significant differences were found in the number of extrasystolic beats of either supraventricular (p = 0.42) or ventricular origin (p = 0.50). In addition, the subjects did not show any potentially dangerous arrhythmias or significant signs of coronary artery disease. However, there was a significant increase in the number of supraventricular beats in the subjects who were not taking β-blockers. Conclusions: The use of 400 µg fenoterol in a bronchodilator reversibility test in elderly subjects does not entail any significant cardiovascular risk.
Asthma is a common disease among elderly persons. The prevalence of asthma in subjects aged over 65 years is 6.5–17%. The diagnosis of asthma is based on typical symptoms with confirmatory information gained from physical examination and laboratory studies. Respiratory symptoms are less specific in older people. Additionally the clinical manifestations of asthma is complicated by co-morbidities, polypragmasy, underreporting of symptoms, cognitive impairment. Moreover, elderly patients are sometimes unable to perform pulmonary function tests. Consequently, discriminating asthma from chronic obstructive pulmonary disease is difficult in this group of patients. The difficulties in differential diagnosis of asthma in older adults entails that disease in the elderly is often underdiagnosed and inadequately treated.
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