Asthma management across ages Asthma in the Elderly

Asthma management across ages Asthma in the Elderly

Asthma management across ages Asthma in the Elderly - Prevalence True numbers are difficult to define because reversible airflow obstruction is poorly perceived, poorly recognized, sub-optimally treated (Parameswarn et al 1998)

Asthma management across ages Asthma in the Elderly - Prevalence • Under-diagnosed (Dow 2000) • 6 -8 % of the general population (luce 1996) • In 80% symptoms began in adult life • Only 30% of adults are atopics (Mygind 1996)

Asthma management across ages Asthma in the Elderly - (under treatment) • Most of those identified had FEV 1 < 56%. • Only 24 % received inhaled steroids with a median daily dose of 400 mcg • 76% received no treatment or only symptomatic relief. • 5% only were on step 3 and 4 of the asthma guidelines. (Parameswarn et al 1998)

Asthma management across ages Asthma in the Elderly These studies highlights the need for improved management of asthma in a potentially vulnerable age group

Asthma management across ages Asthma in the Elderly – Diagnosis Difficult • History of Wheezing is more common than history of diagnosed asthma (luce 1996) • Wheeze & exertional breathlessness often co-exist (Enright et al 1994) • Asthma co-exist with COPD & pulmonary oedema → masked diagnosis (jack & lye 1996)

Asthma management across ages Asthma in the Elderly – Diagnosis Difficult • Irreversible obstruction occurs in 80 % of elderly people with asthma ( Reed 1999) • PEF is difficult in this age group because of poor lung function and are generally frail group • Spirometry is the ideal to obtain objective measure of lung function and to exclude COPD

Asthma management across ages Asthma in the Elderly - Diagnosis • High index of suspicion • Careful history • Demonstrate any variable airflow obstruction.

Asthma management across ages Asthma in the Elderly - Diagnosis Careful history : - • Current medication. (polypharmacy) • Recent initiation of Aspirin, NSAIDS, B-blockers. • Side effects of ACE inhibitors.

Asthma management across ages Asthma in the Elderly - Diagnosis Demonstrate any variable airflow obstruction: - • Reduction in beta adrenoceptor sites & impaired function (luce 1996) • High dose of bronchodilator to demonstrate reversibility • Use MDI (400 mcg) + large volume spacer or nebuliser (2. 5 mg) (BTS/SIG 2004)

Asthma management across ages Asthma in the Elderly - Diagnosis Demonstrate any variable airflow obstruction: - • Mixed airways disease → Ipratropium bromide alone or + B 2 stimulant • Oral steroid trial 30 mg for 2 weeks will show if there is reversibility + if they will benefit from inhaled steroids. • Side effects as gastric irritation

Asthma management across ages Asthma in the Elderly - Treatment Do not be afraid from using • Higher dose of inhaled bronchodilators • Inhaled steroids, • Long acting B 2 • Additional therapies as leukotriene If control is not achieved Refer to exclude other diagnosis.

Asthma management across ages Asthma in the Elderly - Treatment • Routine addition of anticholinegic is not supported ( BTS/SIGN 2004) • If no control → add Long acting bronchodilators (Step 3)

Asthma management across ages Asthma in the Elderly - Treatment If oral theophyllines are used → check blood levels. • Smoking, Anti-Epileptics, Rifampicin→ Reduce Plasma levels • Cimetidine, Erythromycin, Ciproxin → Increase Plasma levels

Asthma management across ages Asthma in the Elderly – Treatment (oral steroid) • Avoid maintenance course if possible BUT Low dose 2. 5 mg may be necessary. • Prednisolone 7. 5 mg /day for six months → bone loss ( NOS 1998) • Oral steroids > 3 months → increase risk of steroids side effects. (BTS/SIGN 2004) • Monitor blood pressure & blood glucose.

Asthma management across ages Asthma in the Elderly – Delivery Systems • Spacers are the best • Nebulisers may be used, but consider dexterity & maintenance issues. • Haleraid ( MDI), Turbogrip (turbohaler) are aiding devices

Asthma management across ages Asthma in the Elderly – Visual Impairment • There are millions of people who are blind around the world and some of them may have asthma. • Some inhalers marking that can be distinguished by touch. • Adhesive labels for Wright’s mini peak flow meter.