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Health & Fitness

Safe treatments for asthma at any age

Special Correspondent
Published:   |   Updated: March 18, 2013 at 01:52 PM

Since the inflammation in the lungs associated with allergy diminishes with age, you might think asthma in the elderly is milder. But this is not necessarily true. Asthma remains a chronic, debilitating illness for the elderly, and many needlessly suffer because the condition is under-diagnosed and undertreated.

The good news is that there are safe and effective treatments available for asthma sufferers of any age.

Asthma is a disease to the lungs in which the bronchi (airways) become inflamed, causing shortness of breath, wheezing and a cough made worse by laughing, lying down, talking and exercise. There are different forms of asthma, including allergic asthma, in which allergens such as pollens, cat and dog dander, dust mites and molds play a major role; non-allergic asthma, in which allergens do not play a role; and infectious asthma, in which viral respiratory tract infections make asthma worse.

All three affect the elderly.

There is little medical knowledge on allergies in older patients, which is why so many in this age group go undiagnosed.

Typically, symptoms of allergic reaction (runny nose and itchy eyes) diminish with age. That's also true of allergic triggers of asthma. Subjects in the elderly age group also often lack biological markers in their blood, such as eosinophils, that indicate an allergic disease exists. In addition, an antibody molecule called IgE that exists in the blood of allergic individuals also decreases in the elderly.

In spite of the fact that these two biological markers decrease in this age group, elderly patients can be susceptible to allergen exposure. For example, allergy skin tests are positive in up to 8 to 12 percent of the elderly group. But, in the younger age group, such tests are positive in up to 20 percent of individuals. Other data show that individuals who develop asthma early in life are much more likely to be allergic, and those who develop it later in life are less likely to be allergic.

Asthma in any age group is exacerbated by irritants such as air pollution, chemical smells and temperature changes, in particular cold air, but also by respiratory tract infections. Up to 80 percent of asthma exacerbations in adults — and in the elderly in particular — are caused by viral respiratory tract infections, such as influenza.

Asthma with advancing age is also associated with many co-morbid conditions, including obesity; gastroesophageal reflux disease (GERD), or heartburn; sleep apnea; chronic sinusitis and other chronic nasal diseases; and psychological problems. These conditions can make asthma worse and more difficult to treat.

If you have asthma, whatever your age, excellent outcomes are the rule with the treatments available today. Ideal care begins with a complete history and physical examination, and with appropriate skin tests to determine your allergens. Avoiding allergens that set off an allergic reaction, and taking appropriate medications and sometimes allergen immunotherapy (allergy shots), is key. Co-morbid conditions should also be eliminated or appropriately treated. All patients with this disease should receive a yearly flu injection and also be immunized against tetanus, diphtheria, and whooping cough and pneumonia.

Remember, asthma is the most treatable of all chronic diseases known to mankind. If you have asthma, with appropriate treatment, you should be able to live a normal life, at any age.

Dr. Lockey is a distinguished university health professor of medicine, pediatrics and public health at USF, where he directs the Division of Allergy and Immunology and holds the Joy McCann Culverhouse Chair in Allergy and Immunology.