A review of the diagnosis and treatment of asthma in older adults was just published in The American Journal of Medicine. Asthma in older adults can fall into two broad groups: those with long-standing disease, present since childhood; and those with late-onset asthma. The review was aimed at this latter group.
With late-onset asthma there is greater likelihood for confusing asthma with other conditions, especially COPD (chronic obstructive pulmonary disease) and congestive heart failure. In pulmonary testing, patients with both COPD and asthma will show obstruction of air flow, but this obstruction improves with inhalation of a bronchodilator in asthmatics, but not in COPD patients.
Another distinguishing fact in pulmonary testing is how the diffusion capacity of gas from lung to blood- stream is normal in asthma, but is decreased in COPD.
In comparing lifelong asthmatics with late-onset, the former more commonly have other allergic symptoms, such as hay fever or food allergy. The former respond very quickly to a bronchodilator, while the older asthmatic may need up to 30 minutes to feel the benefit of a bronchodilator.
Also, older asthmatics often will respond better to a combination bronchodilator with both albuterol and ipatropium, rather than albuterol alone. The inflammatory cells that cause airway inflammation are different. In young asthmatics it’s neutrophils. This fact alone, coupled with the burgeoning baby-boomer population has led to intense research to find anti-inflammatories that work better on neutrophil cells.
Older asthmatics seem more prone to respiratory infections which exacerbate the asthma. In part, this susceptibility is from aging of the immune system.
But another recently discovered cause is that older asthmatics tend to not keep their inhalers and spacers clean, allowing them to become colonized with disease-causing bacteria.