Ageing with Asthma

Older adults (over 65s) are five-times more likely to die from asthma than younger people (Pulmonology Advisor 2019).

Sadly, asthma is often misdiagnosed and overlooked in older adults, despite being just as common as it is in younger populations (Burdon 2015; NACA 2013).

Up to one in seven Australians aged over 65 (or 7-15%) are estimated to have asthma, however, many adult-onset cases are undiagnosed. Furthermore, there is a large prevalence of comorbidity among older people with asthma (NACA 2013; AIHW 2019).

Asthma is a manageable condition but impedes on quality of life and presents significant risks to older adults, especially those who leave it untreated (Pulmonology Advisor 2019; NACA 2013).

Lung Changes With Ageing

Lung function reaches peak performance at around the age of 20-25 before beginning to gradually decrease. While this is a natural decline, untreated asthma can accelerate the process (NACA 2013).

Specific effects of ageing on the lungs include:

• A decline in peak airflow and gas exchange;
• A decline in measures of lung function (e.g. vital capacity);
• Weakening of respiratory muscles; and
• Decreased effectiveness of lung defence mechanisms.

(Dezube 2019)

Risk Factors for Adult-Onset Asthma

• Weight gain or obesity;
• Smoking;
• Exposure to irritants;
• Pharmaceuticals;
• Environmental pollutants;
• Rhinitis;
• Chronic sinus symptoms;
• Respiratory tract infections;
• New habitual snoring;
• Psychological stress.

(Burdon 2015; Pulmonology Advisor 2019)

Approximately 10% of adult-onset asthma cases are caused by occupational exposure to irritants (Burdon 2015).

Why are Older Adults Often Undiagnosed?

Approximately half of those aged over 75 with asthma are undiagnosed. People in this age group often assume their symptoms are simply related to ageing or are being caused by other factors such as weight or lack of fitness. As a result, they are less likely to report their symptoms to a doctor (NACA 2013).

Furthermore, asthma symptoms can be mistakenly attributed to other conditions that affect older adults, especially if they are common and non-specific (e.g. a cough) (Pulmonology Advisor 2019).

Older adults may also be less likely to report symptoms due to:

• Denial;
• Fear;
• Cognitive impairment;
• Depression;
• Social isolation; and
• Poor health literacy.

(Pulmonology Advisor 2019)

Asthma Symptoms in Older Adults

The symptoms of asthma are generally the same regardless of age. If an adult over 65 is experiencing any of the following symptoms, they should seek medical advice:

• Shortness of breath or breathlessness;
• Chest tightness; and
• Wheezing.

(NACA 2013)

Comorbidities in Older Adults With Asthma

More than 50% of people over 45 who have asthma also have at least one comorbidity. Many have more than two (AIHW 2019). Some of the most common comorbidities include:

(Adapted from AIHW 2019)

It is clear that these conditions are significantly more prevalent in people over 45 with asthma than those without.

In addition to the conditions above, people over 45 with asthma may also experience:

• Cancer;
• Diabetes;
• Kidney disease;
• Allergic rhinitis;
• Obstructive sleep apnoea;
• Mental illness;
• Nasal polyps; and
• Gastro-oesophageal reflux disease (GORD).

(AIHW 2019)

Adults with asthma are also 1.4 times more likely to be obese than those without (AIHW 2019).

Managing Asthma as an Older Adult

Older adults can have difficulty managing asthma for a variety of reasons:

• Older adults may be less responsive to typical asthma treatments due to altered airways and systemic inflammation.
• Older adults may have difficulty managing a complex medication regimen.
• Older adults are more likely to experience side effects from asthma medications.
• Older adults may also be taking medications for comorbidities, increasing the risk of medication interactions.
• Older adults may have difficulty using their hands due to conditions such as arthritis, which can cause challenges (e.g. being unable to connect their puffer to a spacer).

(Pulmonology Advisor 2019)

In order to effectively manage their asthma, older adults should:

• Refrain from smoking;
• Avoid irritants that trigger symptoms;
• Seek advice on the most appropriate treatment method (puffer or nebuliser) and how to properly use it;
• Follow their asthma action plan;
• Inform their doctor about any new medications; and
• Seek guidance and advice when required.

(NACA 2013)

Conclusion

Asthma in older adults can be challenging to diagnose and manage, and poses significant risks. Therefore, it is important to ensure older adults report any asthma symptoms so that their condition can be addressed appropriately.

Additional Resources

• Australian Asthma Handbook
• National Asthma Council Australia, Asthma & Older Adults
• Asthma: How Does it Affect the Body?
• Older Adult Respiratory Assessment

References

• Australian Institute of Health and Welfare 2019, Asthma, Associated Comorbidities and Risk Factors, AIHW, viewed 29 July 2020, https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma-associated-comorbidities-risk-factors/contents/asthma-and-associated-comorbidities
• Burdon, J 2015, ‘Adult-onset Asthma’, Australian Family Physician, vol. 44 no. 8 pp. 554-557, viewed 29 July 2020, https://www.racgp.org.au/afp/2015/august/adult-onset-asthma/
• Dezube, R 2019, Effects of Aging on the Respiratory System, MSD Manual, viewed 30 July 2020, https://www.msdmanuals.com/home/lung-and-airway-disorders/biology-of-the-lungs-and-airways/effects-of-aging-on-the-respiratory-system
• National Asthma Council Australia 2013, Asthma & Older Adults, NACA, viewed 29 July 2020, https://d8z57tiamduo7.cloudfront.net/resources/asthma-older-adults.pdf
• Pulmonology Advisor 2019, Asthma in the Elderly: Important Considerations for Diagnosis and Treatment, Pulmonology Advisor, viewed 29 July 2020, https://www.pulmonologyadvisor.com/home/topics/asthma/asthma-management-and-treatment-considerations-in-elderly-patients/