 The Older Person and Asthma
For a comprehensive review see Asthma in the elderly - The Asthma Management Handbook 2006
Asthma in the winter
For the older person with asthma, winter can be quite a challenge. Developing a cold or influenza may have much greater impact on an older person because of other conditions for which they are already being treated such as:
- emphysema, bronchitis
- high blood pressure and heart problems
- arthritis, osteoporosis
- glaucoma, cataracts
- tremor.
Care needs to be taken with the medications older people may need including groups such as aspirin, NSAIDs, beta blockers (either orally or in eye drops) as these drugs may trigger asthma.
Written Asthma Action Plans - a must in any season
The older person with asthma should have a written Asthma Action Plan that is easily available to the individual and any carer(s). If you are a person with asthma and you do not have a written Asthma Action Plan please discuss this with your doctor next time you visit.
Your doctor can work with you to develop your own written Asthma Action Plan and, among other important points, explain the roles of preventer and reliever medication, especially that:
- preventer medication should be taken regularly even when no symptoms are present
- increasing need for reliever medication may indicate worsening asthma.
Your written Asthma Action Plan may need to be updated as your condition changes so you should take your written Asthma Action Plan with you when you visit your doctor.
Useful links:
Asthma Action Plans
First Aid Chart
Vaccinations
Influenza vaccination is especially important for the older person with asthma or other respiratory diseases. Annual vaccination is recommended for all people 65 years and over.
Remember pneumococcal immunisation every five years is recommended for all people 65 years and over.
Choosing asthma medication
As winter sets in, it is a good time to review the medications being used by the older person for their asthma, along with their written Asthma Action Plan and vaccination status.
Choice of medication should include a critical review of not only the drug(s), but also whether delivery system, metered dose inhaler (MDI) or breath-activated device, is appropriate for the individual concerned.
When choosing a delivery system, aspects about the older person with asthma to consider include:
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how strongly they can breath in, their physical overall physical strength, coordination, and agility,
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ability to read labels (size of the print and for languages other than English),
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ability to judge how much medication is left
e.g. red 'empty flags' for Turbuhaler fullness, small lettering on Accuhalers, MDI fullness/gas flows
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how well aids to delivery of medication can be used e.g. Haleraids, spacers
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providing consistency of delivery device type
- where possible, don't mix MDIs, Turbuhalers and so on
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reinforcement of the roles of medications,
e.g. preventers, relievers and symptom controllers - which medication should be taken and when
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understanding of nebulisers
- beware of the reliance that some older persons place on nebulisers, and the false sense of security they may have, so that they do not seek medical attention appropriately.
The National Asthma Council highlights the latest Cochrane Review of the published studies on spacers versus nebulisers.
Holding chambers versus nebulisers for beta-agonist treatment of acute asthma
Cates CJ, Bara A, Crilly JA, Rowe BH
Cochrane Database Syst Rev. 2003;(3):CD000052
Spacers (holding chambers) can be as effective as nebulisers for delivering beta-2-agonist drugs to relieve acute asthma. In acute asthma attacks higher doses of inhaled beta-2-agonists (reliever inhalers) are used to overcome the narrowing of the passages in the lungs. The medication can be given by wet nebulisation or from an inhaler with a spacer device (holding chamber). This review now includes in-patient studies, as well as those in casualty and community setting, comparing these two delivery methods in acute asthma attacks.
In adults, no important differences were found between the two methods, whilst in children those randomised to wet nebulisation spent longer in casualty.
Metered-dose inhalers with a spacer can perform at least as well as wet nebulisation in delivering beta-2-agonists in acute asthma.
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Useful Links from the Asthma Management Handbook 2006:
Asthma in the elderly
- Managing asthma in elderly patients
Drug Delivery Devices
Preventing colds and influenza
Attention to hygiene is important in helping to prevent a cold or influenza whatever your age. Droplets of fluid from your nose or mouth spread cold and influenza viruses to other people.
To help avoid transfer:
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keep your hands away from your eyes, nose, and mouth
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use paper tissues to blow your nose and throw them away after use
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wash your hands thoroughly with soap after blowing your nose, after covering your mouth for a cough or sneeze, and before preparing or eating food
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do not share cups or cutlery with other people (especially if they are showing cold or influenza symptoms).
Managing colds and influenza
Your doctor can assess the severity of your illness, provide information about its expected duration, and advise you on treatment and help you to better manage your asthma through the illness.
Typically:
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get plenty of rest to help your body's immune system fight off the viruses
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drink plenty of fluids to replace fluids lost from your body
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avoid smoking or exposure to cigarette smoke
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use medication to relieve aches and pains, and reduce fever
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inhale steam to clear blocked sinuses and ease chest tightness
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use saline nasal sprays to help clear mucus
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suck ice or throat lozenges, or gargle warm, salty water to help soothe a sore throat
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a decongestant, in the form of nasal spray, drops, tablets, or mixture, may help dry a runny nose or relieve blocked sinuses. Your doctor and pharmacist can advise when conditions such as hypertension mean that decongestants should not be taken.
Useful Links:
Common Colds need Common Sense
Content Updated 1 June, 2006
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