There is some evidence that asthma in the elderly is under-diagnosed. Patients with known asthma comprise 5-9% of people over-65 . Many elderly patients appear to have new onset of asthma after a significant respiratory infection (e.g., common cold). In some cases, the elderly person may have had undiagnosed asthma as a child; in these cases, what seems to be new onset asthma is actually a recurrence.

 

The basic approach to diagnosis is as outlined in section XX :

 

Asthma in the elderly can co-exist with other diseases that may mimic some asthma symptoms. Examples include chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis and emphysema, congestive heart failure, lung cancer, upper airway obstruction, bronchiectasis and pulmonary edema. All these can cause breathlessness, so the diagnosis of asthma can be masked.

 

Some elderly people have difficulty with lung function testing, either because they are generally frail or because their lung function is poor.

 

Sometimes elderly patients do not use metered dose inhalers very successfully. Their technique is better when using a breat- actuated device (e.g., Autohaler). Some may have inadequate inspiratory (taking an in breath) flow to use the dry powder inhalers. Others may prefer an MDI and spacer or a nebulizer, particularly when portability is not of concern. For patients of any age who have trouble with manual strength or dexterity, you may be able to obtain a Haleraid (for GlaxoSmithKline MDIs) or the Turbogrip (for the AstraZeneca Turbuhaler). These assistive devices are not generally available in the US, but your health cre provider may be able to obtain them through their pharmaceutical representative.