Asthma in the elderly

Abstract

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.

Characteristics and self-rated health of overlap syndrome

“…Airflow obstruction appears to be more of a fixed pattern in the elderly with asthma, whose symptoms worsen and respond poorly to treatment 20. Similarly, the prevalence of AHR in COPD patients is increased as much as 3× in the elderly compared to non-elderly patients 21. Studies have shown that 50% of the elderly with airway disease have airflow variability with some degree of irreversible airway obstruction 4,22.…”

Is the diagnosis of asthma different in elderly?

“…BHR increases from 10-16% to 29-43% by age, but it is not helpful after the development of the fixed air way obstruction (5,11).…”

“…Majority of the persons died from asthma are aged 65 and above. Death rate is 2.8/100.000 between 55-59 years old, while it increases to 4.2/100.000 between 60 and 64 (2,5).…”

Asthma phenotypes

“…Comparing asthma which occurs in those aged over 65 and in nonaged asthma, in aged asthma, the decline with age the flow of volume in one‐second is large and although respiratory tract reversibility was seen, in nonaged onset, there was a remarkable deterioration of respiratory function. Respiratory tract indicated reversible response and remodeling impact was implied . Moreover in aged onset, night symptoms were small and seasonality was seen mostly during the winter, and the most common feature was COPD (chronic obstructive pulmonary disease).…”