Perception of Bronchoconstriction in Elderly Asthmatics

Abstract

The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37, group 2, > or = 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, > or = 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 +/- 0.17; group 2, PS20 = 1.37 +/- 0.12, p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (IA, 2.63 +/- 0.30 and IB, 2.07 +/- 0.16, p = 0.101; 2A, 1.36 +/- 0.19 and 2B, 1.59 +/- 0.120, p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and % FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.

Sensory and Affective Aspects of Dyspnea Contribute Differentially to the Borg Scale’s Measurement of Dyspnea

“…Moreover, although age was not a significant predictor of Borg scale ratings in our regression analyses, we cannot say whether older age might lead to different results, because we examined a rather young sample. Since other studies have reported an influence of older age on the perception of dyspnea [41, 42], future studies comparing different age cohorts are clearly needed to answer this question.…”

Respiratory Symptom Reporting Error in Occupational Surveillance of Older Farmers

“…Individuals in this age group may not perceive respiratory decrements to the extent that younger individuals do. 15 Con- versely, older farmers who highly value the ability to continue farming regardless of health impairments 5 may disregard or underreport perceived symptoms that may be a harbinger of the end of field work. Whatever the reason, subjective reports of respiratory symptoms may not adequately characterize current health status.…”

“…11,12 Elderly patients with longstanding disease may have more severe airway obstruction than new-onset asthmatics but they complain less of dyspnea or wheeze. [13][14][15] Spirometry is considered a reliable and useful screening measure in older populations, [13][14][15] and an FEV 1 of 80% or less of predicted values can be used as an indicator of risk for obstructive disease in the elderly. 16,17 Symptoms which might point to asthma or obstructive disease in older adults includes nocturnal-associated breathlessness, dyspnea on exertion, rhinosinusitis, hay fever, daytime sleepiness, bronchitis, chest tightness, cough, atopic dermatitis, and wheeze.…”

Der ältere Asthmapatient

“…Dieser Faktor mag dazu beitragen, dass ältere Patienten die Schwere der Erkrankung oftmals unterschätzen. Bei Untersuchungen über die Wahrnehmung von Obstruktion verglichen Ekici et al [12] verschiedene Altersgruppen von Asthmatikern (<60 vs. >60 Jahre). Zusätzlich wurde geprüft, ob die Fä-higkeit zur Obstruktionswahrnehmung mit der Erkrankungsdauer korreliert.…”

“…Die Art und Weise, wie Patienten ihre Asthmasymptome (etwa Atemprobleme, nächt-liches Husten, Atemgeräusche) wahrnehmen und interpretieren, ist entscheidend dafür, wie sie ihrem Arzt gegenüber die Intensität der Symptome schildern und sich im Alltag verhalten. Beispielsweise werden Symptome einer sich verschlechternden Atemwegssituation, wie etwa Atemgeräusche, Giemen ("wheezing"), von älteren Patienten im Vergleich zu jüngeren häufig nicht oder nicht angemessen wahrgenommen [19], unterschätzt oder als Alterserscheinung interpretiert [12]. Notwendige medikamentöse und nicht-medikamentöse Maßnahmen werden so vom Patienten nicht oder zu spät eingeleitet.…”