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Managing Asthma and Pulmonary Thromboembolism in Older Adults

Learn about asthma in later life and diagnosing pulmonary thromboembolism in the elderly. Discover treatment approaches and pharmacotherapy. Explore key symptoms and staging, along with evaluation and therapy methods.

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Managing Asthma and Pulmonary Thromboembolism in Older Adults

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  1. Respiratory Disorders Module 3. Asthma and Pulmonary Thromboembolism

  2. Process • Step 1. Complete Module #3 with voice overlay • Step 2. Answer the question following Module #3 • Step 3. This completes all the modules in the respiratory unit, you can either move on to another unit or take a break.

  3. Module #3 Learning Objectives • Describe the definition and diagnostic features for asthma and how this disorder differs in later life. • Explain how the stage of severity of asthma directs treatment • Outline the approach to evaluation of suspected pulmonary emboli and treatment of this process when that diagnosis is confirmed

  4. Asthma: Prevalence & Mortality • Second peak in prevalence after age 65 • 5-10% after 65 yrs meet criteria for obstruction & bronchial hyperactivity • 45% of all asthma deaths after 65 yrs

  5. Asthma: Definition • Chronic inflammatory disorder of airways • Triggers: • Air pollutants • Allergies • Chemicals • Emotional distress • Exercise • Tobacco smoke • viruses

  6. Asthma: in later life • Cough is a common presentation • Air flow restriction is less variable and episodic • Presents more fixed obstruction • More difficult to classify • PEF less reliable

  7. Classic Symptoms: Image from :http://www.images.md In older patients DDX of this same set of symptoms includes: Heart Failure COPD Asthma: Symptoms

  8. Asthma: Diagnosis & Staging

  9. Asthma: Nonpharmacologic Therapy • Avoid triggers • Educate on disease management • Use of MDIs/ peak flow meters

  10. Asthma: Geriatric Pharmacotherapy * SR-TH= slow release theophylline ** LK=leukotriene modifiers/inhibitors

  11. Pulmonary Thromboembolism (PE) • Incidence increases with age • 3.5/1000 60-74 years • 9/1000 after age 75 • 30% fatality untreated • Many conditions common in old age mimic

  12. Classic Triad Dyspnea Chest pain Hemoptysis Occurs in < 20% of cases Any of these: Dyspnea Chest pain Hemoptysis Hypotension Hypoxia Syncope Tachycardia PE: Symptoms

  13. PE: Evaluation Suspect PE High Anticoagulate VQ Scan Intermediate Evaluate Further Low No Treatment

  14. PE: Evaluation Suspect PE Angiography Unstable VQ Scan Inter- mediate Or Stable Ultrasound LEs Or D-dimer > 500 < 500 No Treatment

  15. PE: Evaluation Suspect PE VQ Scan Intermediate Stable Ultrasound LEs Negative or Nondiagnostic Positive Comprehensive US of LEs, serial US LEs, or Helical CT Anticoagulate

  16. High-probability VP lung scan Image from :http://www.images.md

  17. Angiogram Showing Main Pulmonary Artery Thromboemboli Image from :http://www.images.md

  18. First line: low molecular weight heparins Unfractionated IV heparin if renal failure If using IV heparin do not bolus When warfarin started do not load Acute Massive PE (filling defects ≥ 2 lobar arteries) hypotension, severe hypoxia or high pulmonary pressures on echo Treat with thrombolytics PE: Therapy

  19. References • Reuben DB, Herr KA, Pacala JT, Pollock BG, Potter JF, Semla TP, eds. Geriatrics at Your Fingertips, 7th Edition, American Geriatrics Society, New York, NY, 2005. Respiratory Diseases pp167-176 • Geriatric Review Syllabus: a core curriculum in geriatric medicine. Fifth Edition 2002-2004. E. L. Cobbs, E.H. Duthie, J.B. Murphy (Eds). • Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators.JAMA. 1990;263(20):2753-9. • Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) . NHLBI/WHO Workshop Report, Executive Summary. National Institutes of Health, National Heart, Lung and Blood Institute. March 2001. NIH Publication No. 2701A. http://www.goldcopd.com. • National Asthma Education and Prevention Program, NAEPP Working Group Report: Considerations for Diagnosing and Managing Asthma in the Elderly. Bethesda, MD: National Heart, Lung, and Blood Institute; Feb. 1996. NIH Publication No. 96-3662; • Global Initiative for Asthma, Global Strategy for Asthma Prevention and Management. Bethesda, MD: National Heart, Lung, and Blood Institute, April 2002. NIH Publication No. 02-3659. http://www.ginasthma.com.

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