Questions and Answers:
1. Do you know why mortality rates for elderly asthma patients have been rising more rapidly than for younger patients?
No one really knows, but there are several possibilities. When elderly people developed asthma, it used to be diagnosed as emphysema or bronchitis, but now we know that asthma can occur at any age. So it may not be a real increase in incidence, but simply better recognition. Second, as the population has aged in the last several decades, many diseases occur more commonly than they did years ago. We didn’t use to see many 80-year-olds with asthma because there weren’t many 80-year-olds around. When an elderly asthmatic dies, it’s not necessarily from the asthma. There may also be other factors that we don’t know about yet — ambient air quality, second-hand smoke. But I think better recognition is the most important factor.
2. Does asthma tend to be more severe in the elderly due to aging factors?
Again, this is not really known. My guess is that it’s because as people get older, lung function deteriorates. When you put asthma on top of that, patients do get much more symptomatic. Some, but not all, asthmatics get worse and worse over the years because of an excessive decline in lung function. If you live long enough, it’s going to lead to very severe disease. Research is just now being conducted to find out why and how often this happens. In part, it’s aging factors, and partly the chronicity of the asthma itself in some patients.
3. What complications of asthma are specific to elderly patients?
Elderly patients are more likely to develop problems tolerating their drugs, and interactions with other medications. Beyond that, I can’t really say that there are any complications specific to the elderly asthmatic.
4. What is the advantage of the shift to using long-term treatment strategies, especially with regard to the elderly?
Overall, there is much more emphasis on preventive therapy in asthma. Inhaled corticosteroids are anti-inflammatory in the lungs, and can prevent flare-ups, exacerbations and worsening of lung function. This leads to less utilization of the health-care system, fewer emergency-room visits, hospitalizations and so forth. Elderly people don’t perceive their symptoms as well, especially breathing problems, and are more likely to delay going to the hospital until symptoms are severe because they’re reluctant to complain, so anything we can do to prevent worsening of the disease would be advantageous, as it would in any patient with any disease.
5. Can people develop asthma at any age, or is the asthma seen in elderly patients really the continuation of a previous chronic condition?
I’ve seen patients in their 70s, 80s — even a 90-year-old I saw recently — develop asthma for the first time. It’s not known what causes this, but the leading theory is that it’s a viral respiratory disease that just goes haywire. What’s thought is that the inflammation from the acute infection for some reason stays in the lungs and worsens, and this eventually leads to some of the changes of asthma. Which viruses or other organisms are responsible is unclear. Some investigators think it may be a latent virus that’s been dormant in the body for years, even since childhood, until something, perhaps another respiratory virus or some kind of stress to the immune system, triggers a flare-up — as in shingles from chicken pox or fever blisters from the herpes virus. I wish I had more definitive answers, but this is all just conjecture at this point. What’s certain is that much research remains to be done in this field.