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Bronchial Asthma in the Elderly

Bronchial Asthma in the Elderly. Presented by: Dr. Naif Shroof FRCP, FACCP, FACP Prof of medicine Jordan University Hospital. Bronchial Asthma. Definition

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Bronchial Asthma in the Elderly

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  1. Bronchial Asthma in the Elderly Presented by: Dr. NaifShroof FRCP, FACCP, FACP Prof of medicine Jordan University Hospital

  2. Bronchial Asthma Definition Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airways hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible spontaneously or with treatment.

  3. Comparison of diagnostic features of patient with asthma with those with COPD

  4. Bronchial Asthma in The Elderly • Little is known about the natural history of asthma in elderly patients, • But there is evidence in literature that the elderly asthmatic patient is underdiagnosed, undertreated, has higher risk of hospitalization, has a lower quality of life, and experiences greater morbidity and mortality.

  5. Reasons for under diagnosis of Asthma • Dyspnea is caused by aging • Reduction in perception of dyspnea • Self-limitation of activities • Social isolation • Depression • Misconception that adult-onset asthma is rare • Comorbid conditions

  6. Physiologic Changes in Elderly • Decreased lung elastic recoil • Decreased strength of respiratory muscles • Decreased chest wall compliance • Impaired respiratory reflexes ( B-agonist responsiveness) • Reduced mucociliary clearance

  7. Factors Thought to Contribute to such Risk Include: • Delay in diagnosis and treatment • Poor cardiovascular reserve • Impaired perception of airway obstruction • Blunted hypoxic ventilator drive • Psychosocial problems • Cognitive problems

  8. Diseases that Mimic Asthma • Chronic obstructive pulmonary disease • Congestive heart failure • Bronchiectasis • Upper airway obstruction • Aspiration or inhaled foreign body • Hyperventilation/panic disorder • Churg-Strauss syndrome and other vasculitides

  9. Making Diagnosis of Bronchial Asthma in The Elderly • Symptoms: Atypical presentation is common in elderly; high index of suspecion for diagnosis is needed with isolated dyspnea, cough or wheezes. • Spirometry (gold standard): shows reversibility of at least 12% of FEV1 and 200 ml.

  10. Other investigations maybe needed • Spirometry • Arterial Blood Gas • Chest X-ray • Fractional expiratory Nitirc Oxide • ECG • H.R.C.T Scan • Allergic skin test • DLCO (diffusion capacity) • Brocho Alveolar Lavage

  11. Classification of Asthma Severity by Clinical Features • Intermittent •  Symptoms less than once a week •  Brief exacerbations •  Nocturnal symptoms not more than twice a month •  FEV1 or PEF > 80% predicted •  PEF or FEV1 variability < 20% • Mild Persistent •  Symptoms more than once a week but less than once a day •  Exacerbations may affect activity and sleep •  Nocturnal symptoms more than twice a month •  FEV1 or PEF > 80% predicted •  PEF or FEV1 variability < 20%–30%

  12. Classification of Asthma Severity by Clinical Features…continued • Moderate Persistent •  Symptoms daily •  Exacerbations may affect activity and sleep •  Nocturnal symptoms more than once a week •  FEV1 or PEF 60%–80% predicted •  PEF or FEV1 variability > 30% • Severe Persistent •  Symptoms daily •  Frequent exacerbations •  Frequent nocturnal asthma symptoms •  FEV1 or PEF < 60% predicted •  PEF or FEV1 variability > 30%

  13. Features of Asthma in Adults To be continued…

  14. Features of Asthma in Adults… continued

  15. The goals for Successful Management of Asthma • Achieve and maintain control of symptoms. • Prevent asthma exacerbations. • Maintain P.F.T.s as close to normal as possible. • Maintain normal activity level. • Avoid adverse effects from asthma medications. • Prevent asthma mortality.

  16. Recommended medications vs. level of severity

  17. Asthma drugs that worsen comorbid conditions • 𝛽 agonist • Arrythmias • Tremors • Hypertension • Hypokalemia • Theophylline • Gastroesophageal reflux • Tremors • Insomnia • Corticosteroids • Existing osteoporosis

  18. Drugs that worsen Asthma • Hypertension • 𝛽 blockers and ACE inhibitors • Glaucoma • Topical 𝛽 blockers • Arthritis • Acetylsalicylic acid (ASA)/Non steroidal anti-inflammatory drugs (NSAIDs)

  19. Conclusion • Though prevalence of asthma in old and young people is similar; asthma is under-diagnosed and under treated in elderly. • The higher incidence of co-morbid conditions makes diagnosis and treatment more difficult. • Despite the availability of effective drugs, many of asthmatics, in general, remain uncontrolled.

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