Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale.

Abstract

The death rate from asthma is highest in old age and continues to rise, despite diagnostic and therapeutic advances.'3 Acute attacks of asthma in older people with chronic asthma may be very rapidly fatal4 and have been said to have a poorer prognosis than in the young.5 Of the many potential reasons for the higher mortality from asthma in old age, the possibility of impaired awareness of the severity of an acute asthmatic attack by the elderly patient, his physician, or both has been little investigated. Petheram et al 6 showed that during acute exacerbations of asthma elderly patients have less pronounced pulsus paradoxus and tachycardia than younger patients with similar airway obstruction and blood gas abnormalities. They argued that this might theoretically result in undertreatment of the elderly asthmatic patient during an acute attack. Treatment might also be inadequate if the severity of the attack were also underestimated by the patient. This may indeed be the case in the elderly. Elderly asthmatic patients tend to deteriorate for longer periods at home before admission,6 and when challenged with inhaled methacholine they do not report dyspnoea or wheeze to be troublesome despite a minimum fall in one second expiratory volume (FEV,)

Airway hyperresponsiveness in the elderly: prevalence and clinical implications

“…CONNOLLY et al [78] have demonstrated that, even in healthy subjects, elderly individuals experience less awareness of bronchoconstriction during methacholine bronchoprovocation, despite similar degrees of bronchoconstriction. This observation has been confirmed by a recent study on elderly asthmatics [77].…”

Older Adults with Chronic Lung Disease Report Less Limitation Compared with Younger Adults with Similar Lung Function Impairment

“…Third, it is possible that sensory differences associated with aging may have influenced our results. For instance, prior studies have suggested that perception of bronchoconstriction may be blunted in elderly individuals (24) and that normal aging alters the perception of resistive ventilatory loads, elastic loads, and the sensation of lung volume changes (25)(26)(27). There is conflicting evidence about whether elderly adults have a blunted or enhanced perception of dyspnea (28,29).…”

Geriatric dyspnea: Doing worse, feeling better

“…Moreover, older asthma patients report less obstruction and less chest tightness in response to methacholine-induced bronchoconstriction (Connolly et al, 1992). These findings are particularly interesting since older individuals require lower methacholine doses to induce a clinically relevant, 20% drop in lung function and take longer to recover after receiving medication to reduce bronchoconstriction (Connolly et al, 1995).…”