Although often regarded as a disease of childhood, asthma is common in elderly people, affecting approximately 4 to 8% of those above the age of 65 years. Despite its prevalence, especially late onset asthma may be misdiagnosed and inadequately treated.

The nonspecific presentation of asthma in elderly adults means that the diagnosis of asthma is difficult to make. Occasionally, atypical symptoms such as chest pain or tightness may imitate other diseases more common in the elderly, like ischaemic heart disease. It is therefore important to employ objective measures such as spirometry or bronchoprovocation testing to confirm the diagnosis.

Patients with persistent disease should receive inhaled corticosteroid therapy. Since inhalation technique can be a particular problem in elderly patients with asthma, a careful choice of inhaler device is required and thoroughly instruction, especially in the use of metered-dose inhalers is especially important.

Additionally elderly patients often suffer from multiple diseases and administration of numerous medications in this age group enhances the risk of adverse effects from oral preparations, thus the inhaled route should be preferred wherever possible. Inhaled corticosteroids appear to be relatively well tolerated when administered at doses below approximately 1000 µg daily. However, larger doses of inhaled corticosteroids may affect hypothalamic-pituitary-adrenal function.

Concerns about osteoporosis with long-term corticosteroid therapy (both oral and inhaled), the risk of arrhythmias or hypokalaemia with β2-agonists and the significant side-effects of theophylline may justify the application of anticholinergic and/or anti-leukotriene therapy. The risk of interactions with other therapeutic agents also requires a more intense monitoring of asthma treatment. Adverse effects such as hypokalaemia can be aggravated by concomitant treatment with other drugs promoting potassium loss including diuretics, corticosteroids and theophyllines. Additionally, relatively minor adverse events associated with the administration of ß2-agonists, such as tremor and blood pressure changes, may be of significance to the elderly patient leading to impairment in the quality of life.


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