Asthma in the Elderly
Despite the similarity of national and international guidelines for diagnosis and treatment of all ages, asthma in the elderly is a very different problem than asthma in children or younger adults. Diagnosis in this age group is particularly difficult because elderly patients frequently have coexisting lung diseases that contribute to the development of irreversible airway obstruction. Treatment is more difficult because of adverse effects of medications, especially on the heart. And death from asthma and other complicating lung diseases increases with age.
There are three kinds of questions about asthma in the elderly: WHAT? HOW? and WHY? WHAT? questions are about epidemiology: What is the frequency, age of onset, death rate? HOW? questions are about the diagnosis and treatment: How do we diagnose and treat asthma in the elderly? WHY? questions are about pathogenesis: Why is the airway obstruction incompletely reversible in so many elderly patients? Why do they develop it when they do? Why do older individuals more often develop asthma that is intrinsic rather than allergic? Why in severe asthma are some segmental bronchi completely occluded with mucus plugs? The WHAT and HOW questions have been reasonably well answered [1– 5]. Some answers to the WHY questions may be found in the innate immune response to agents from the environment.
KeywordsAirway Remodel Churg Strauss Syndrome Allergic Bronchopulmonary Aspergillosis Intrinsic Asthma Late Onset Asthma
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