Bronchial asthma is characterised by chronic airway inflammation and hyperresponsiveness.
Chronic airway inflammation results from the interaction of various types of cells and hyperresponsiveness of the airway implies that the trachea is highly sensitive and engages in excessive or premature contraction as a response to various stimuli.
Airway hyperresponsiveness, bronchoconstriction, and mucus secretion ultimately lead to structural changes of the airways known as airway remodelling.
There are approximately 315 million asthma patients worldwide, and the prevalence is 0.7-11.9%. By contrast, the prevalence of asthma in older adult patients is 6-17% and is increasing, especially in older women. Severe asthma accounts for 13.9%, and its treatment cost is high, severely increasing social burdens. Asthma mortality rates are high among older adults, often related to insufficient diagnosis and delayed treatment.
The complexity of asthma, the baseline decline of lung function in the older adult (which is heterogeneous among individuals and varies greatly with age), and differential responses to treatment also complicate diagnosis and treatment in this population. Various asthma phenotypes may make treatment more difficult. The disease is more severe, less sensitive to medication and more prone to airway remodelling.
Different phenotypes require different treatments and older adult people have late-onset asthma (usually after 40 years of age or older). Therefore, the proper treatment requires an appropriate diagnosis. Asthma control in older adults depends on many factors.
Studies show the relationship between asthma control and compliance in older adults and young adults suffering from asthma and found that comorbidities had a negative impact on treatment compliance. Asthma in the older adult differs from asthma in the young in many other respects, including genetic susceptibility, environmental influences, pathogenesis, type of airway inflammation, course of the disease, comorbidities, hospitalisation rate, and treatment outcome.
Asthma progression leads to diminished quality of life, characterised by limited activities and loss of the ability to function independently and socially.
Repeated hospitalisation is associated with deterioration of the condition, making treatment more difficult. This phenomenon worsens the outcomes and aggravates the economic burden on patients and their families. Most studies focused on children and adults or targeted patients without comorbidities.
Recent studies conclude that frequency of bronchial asthma among older adult patients is high, and more so in women than men. Older adult patients with asthma have a long course of illness and tend to be heavy smokers. They are diagnosed late and have poor asthma control.
Older adult patients with asthma have many comorbidities, poor lung function, and severe outcomes suffering attacks. Few of the older adults regularly use inhaled corticosteroids. Doctors should pay more attention to older adult patients with asthma, encourage them to quit smoking, educate older patients about the need for controlling asthma, assess cognition, assess the understanding of how to use devices to assure compliance, educate on the importance of rest, avoiding respiratory infections, and exercising, and performing comprehensive geriatric assessments.
Doing so might lead to better management of the older adult patient with bronchial asthma.
Article submitted by the HPA Health Group
