Respiratory Allergies and Their Modifications in Patients Over 45 Years of Age†

Abstract

By and large, respiratory allergies in patients over 45 years of age present increasing problems of complications and differential diagnosis. Upper respiratory tract allergies and chronic infections are frequently accompanied by the development of manifestations of hypersensitiveness in the lower respiratory tract, such as allergic bronchitis, bronchial asthma, and emphysema. These pulmonary changes, if neglected or poorly managed, frequently predispose with age toward the development of permanent and irreversible pathologic structural changes. In older asthmatics, very frequently asthma is a progression from chronic sinusitis based upon an acute infection or a developing allergy earlier in life, often in childhood. Pertussis, croup, scarlatina, rubella, or other acute childhood infections, bronchopneumonia, recurrent attacks of acute tracheobronchitis, and adenitis of the upper respiratory tract may start the vicious cycle.Regardless of the primary etiologic factor, as life goes on there develops progressive bronchial spastic disease, due either to chronic bronchial asthma or to chronic pulmonary emphysema. The pathologists have furnished evidence that these are linked together.Allergy must now be considered as a clinical entity with its various phases integrated by known factors or implications. Therefore, this presentation aims to avoid controversial and confusing problems and deals with the practical clinical aspects of chronic respiratory allergic manifestations.BRONCHIAL ASTHMA This is the most important of the respiratory allergies, because of its frequency, the crippling development of complications in the older age groups, and the comparatively high death rate. In prolonged bronchial asthma, pulmonary emphysema is an inevitable complication which results in greater permanent disability than do the paroxysms of asthma. In asthmatics who have had symptoms continuously for more than ten years, chronic emphysema develops. Obviously, if the acute paroxysms can be prevented at the time of onset, the emphysema can be prevented. Patients who are taught the self-administration of epinephrine at the onset of their frequent paroxysms and who carry this out through the years, are able to prevent the development of emphysema.It is particularly in the older age group that the instances of so-called "intrinsic" asthma occur, although intrinsic asthma in early life is not unusual.

Allergy in the Aged

“…In the younger patient, elasticity and, therefore, reversibility after each asthmatic attack tend to prevent structural changes. 11 Bullen,12 in correlating clinical and autopsy findings in 176 cases of asthma, found some degree of emphysema in all but six patients. In all these patients the onset of symptoms occurred between ages 30 and 60.…”