1 / 19

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).

davidweldon
Download Presentation

Asthma in the Elderly

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Asthma management across ages Asthma in the Elderly

  2. 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)

  3. 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)

  4. Asthma management across ages Asthma in the Elderly -(under treatment) • Most of those identified had FEV1 < 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)

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

  6. 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)

  7. 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

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

  9. 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.

  10. 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 (400mcg) + large volume spacer or nebuliser (2.5mg) • (BTS/SIG 2004)

  11. Asthma management across ages Asthma in the Elderly - Diagnosis Demonstrate any variable airflow obstruction:- • Mixed airways disease → Ipratropium bromide • alone or + B2 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

  12. Asthma management across ages Asthma in the Elderly - Treatment Do not be afraid from using • Higher dose of inhaled bronchodilators • Inhaled steroids, • Long acting B2 • Additional therapies as leukotriene If control is not achieved Refer to exclude other diagnosis.

  13. 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)

  14. 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

  15. 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 7.5mg /day for six months → bone loss • ( NOS 1998) • Oral steroids > 3 months → increase risk of steroids • side effects. (BTS/SIGN2004) • Monitor blood pressure & blood glucose.

  16. 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

  17. 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.

More Related