Asthma is one of the most troublesome diseases of recent years and is generally known as childhood and youth disease. However, we know that there has been a very serious increase in the number of asthmatic patients in the last 30 years, and when we look at the age spectrum of these patients, we see that we have not a small number of elderly asthmatic patients. Yes, it is possible to talk about a prolonged human lifespan in recent years, compared to ancient times and even years, so an increase in our elderly population is inevitable. For this reason, we see our elderly people much more than before, both in our lives and in our clinics. It should be one of our primary duties for them to live a healthy and peaceful life. When the studies are reviewed, it is difficult to diagnose asthma in the elderly and because of the possibility of confusion with many diseases, misdiagnoses are quite high. Although we easily come to the conclusion that many of our patients actually have asthma, unfortunately, these elderly people are distracted by misdiagnosis and unnecessary drugs, and perhaps they lose their health more and more every day. In fact, if the diagnosis and treatment management of a correctly diagnosed elderly patient with asthma is performed by a physician related to this job, it is possible to lead a very healthy life.
According to the 1963 report of the World Health Organization, old age was defined chronologically. According to this; 45 to 59 years old, middle-aged; 60 to 74 years old, seniors; Those aged 75 and over are defined as the advanced elderly. According to the United Nations Report (1980), aging begins after the age of 60. However, we see that these figures have a tendency to increase over the age of 65 in the recent period. When we look at the population distribution of our country, we see that the number of elderly people and therefore their ratio to the population is increasing. In 1990, the ratio of our people over the age of 65 to the general population was 4%; While it was 6.1% in 2010, this rate is expected to be 7.7% in 2010 and around 9% in 2025. Therefore, our elderly population is increasing and will increase in parallel with our development. Our duty is to take care of our elders so that they can lead a healthy life, to find definitive solutions to all their problems with the right and appropriate approaches, and to treat their diseases in the best way possible.
Although it is known that allergic diseases are diseases of childhood and youth in general, the number of patients who show their first symptoms in old age is not small at all. For this reason, allergic asthma can also occur in old age and should be diagnosed correctly.
We think that asthma will create more and more problems every year as a serious health problem in elderly people, when the average human lifespan is getting longer and environmental factors are also taken into account. Currently, the prevalence of asthma is 6-7% in the general population of Turkey, 5-8% in children and 5% in adults; In international data, 4-10% of asthmatic cases over 65 years of age are seen. Again, when we look at the table in general, we see that asthma that starts in childhood and adulthood is mostly in the form of allergic asthma; however, we see that our elderly patient also presents with allergic asthma.
We see 3 types of asthma in our elderly cases. The first of these is Type-A, where the disease has existed since childhood and/or adolescence and continues with exacerbations and extinctions until old age; the second is Type-B, in which asthma symptoms appeared in childhood and/or youth, but then remained silent for years with treatment, and eventually the findings reappear in old age; Finally, it is Type-C, in which the symptoms of asthma appear and are diagnosed in old age. Regardless of the type, it is obvious that we have difficulties in both diagnosis, treatment and follow-up in these cases in our practical applications. However, with the right choice of physician, it is easy to get rid of these three difficulties (diagnosis + treatment + follow-up = 3T).
It should be kept in mind that there are or may be significant difficulties when taking anamnesis and disease history during diagnosis, therefore, it is necessary to listen to the patient patiently and spend time on this issue. It should be known that there are co-morbidities that may exist in the elderly, and that many drugs used may cause symptoms of asthma and similar clinical pictures. For this, it will be necessary to know and evaluate the effects of many diseases and drugs on asthma symptoms. The accuracy and reliability of the tests used during the laboratory diagnosis can also vary considerably according to the practice and experience of the physician performing the evaluation. For this reason, enough time should be allocated to the patient, the tests should be applied meticulously, and the whole picture should be tried to be seen by taking into account the previous experience of the physician in the diagnostic evaluation. As the most confusing situations during diagnosis; heart failures, emphysema, chronic bronchitis, chronic obstructive pulmonary disease (COPD), gastro-oesophageal reflux (GER) and tumors. In addition, anti-hypertensives, non-steroidal anti-inflammatory drugs (rheumatism drugs) and beta-blockers (which are used especially in cardiovascular diseases, high blood pressure and rhythm disorders) used by our patient should be reviewed as they may worsen asthma symptoms. While doing the tests, we should keep in mind that we can get weak answers, especially in terms of IgE tests, considering the basic immune response changes in the elderly. For this reason, it is an absolute necessity that these tests are performed by allergy and immunology specialists who are well-versed in the subject.
There may also be difficulties in treatment. These are the main points: The disease tends to be more chronic; many elderly are followed by general practitioners rather than specialists; response to drugs is much less; drug side effects are much more common; there may be incompatibility with drugs used for other diseases; treatment may be irregular in the elderly living alone; little compliance with medication (especially inhalers); Difficulty in use is observed due to restriction in cerebral and motor functions. When we look at the variables here, it is understood that the treatment of the disease must be done by professionals. We should have the right doctors treat these special diseases of our elderly people, who are a very special population.
Difficulties experienced in treatment may also be encountered during follow-up. We know that asthma is generally chronic; therefore, it is a disease that must be followed for a long time. On this occasion, our elderly patients with asthma should come for routine controls. However; The possibility of coming to routine controls in the elderly is less than in the young and adults. Here, too, patient education comes to the fore, and we need to spend enough time educating our elderly about the seriousness of their illness and follow-up. When we look at all the steps, it is necessary to spend a lot of time and effort for the diagnosis, treatment and follow-up of the disease. However, all of these are necessary for the health and happiness of our elders. Since it is known that elderly asthmatic patients can often apply to the emergency room and go to the doctor with acute attacks, our obligation to inform all our physicians about the emergency attack treatment of this disease during medical education also comes to light. PEF and spirometry applications used during follow-up may cause difficulties due to device incompatibility, muscle weakness, increased chest wall rigidity, incorrect applications, dizziness due to forced expiration, and bronchospasm due to forced expiration.
Our goals in the treatment of our elderly patients can be listed as follows:
– Ensuring normal daily activities including exercise,
– Preventing chronic symptoms,
– Minimizing admission to the hospital due to an attack, including the emergency room,
– Choosing drugs with the least or no side effects,
– Informing the patient and their relatives enough about the disease and its course…
As it is known, there are many drugs and application methods in the treatment of asthma. However, it is necessary to choose the appropriate medicine and device for the person. According to age, effort capacity, physical activity and economic situation, the most appropriate, least side-effect and absolutely indicated drug/drugs should be used. Your professional and experienced physician will assist you in the right treatment.
Wishing you healthy days…
Prof. Dr. Cengiz KIRMAZ
