Tip #21
ASTHMA AND ALLERGIES
IN SENIORS

Contrary to popular belief, the symptoms of allergic diseases, including asthma, can first make their appearance when people reach retirement age. A patient who develops chest symptoms later in life may not necessarily suffer from chronic bronchitis or emphysema, but rather may have developed a reversible obstructive airways disease, i.e., asthma.

Allergy in seniors is similar to allergy in younger adults. Although the onset of allergies is less common in people over age 60, asthma may develop at any time and any age. In some cases, asthma that first begins in adult life may be more persistent and resistant to standard medications. There also may be a wider range of triggers for asthma attacks in seniors, and allergic asthma is less common. Allergies often cause nasal and eye symptoms as well as asthma.

Changes Require Adjustments
Learning to cope with the new onset of a disease that threatens normal breathing and daily activities would be difficult at any age, but in a senior the problems may be compounded with other changes requiring new adjustments, such as retirement, change in residence and limited resources. The economic as well as emotional impact of the asthma must be addressed. This also requires an understanding of the illness and how it affects other body functions.

If a person retires and moves to a new location with a different climate and plants, it is possible that in one or two years, the person's body will respond to these new allergens with typical allergy symptoms such as sneezing, itchy eyes and runny nose. At first one might suspect a "summer cold," but if the symptoms recur often and seem never-ending, the sufferer should consider the possibility of allergies.

Allergies
Food allergies are not very common in seniors and should not be blamed for symptoms such as stomach upset or changes in bowel habits until other more common causes are evaluated. The symptoms associated with food allergies, such as cramping and diarrhea, may have a variety of other causes and should not be assumed to be an allergy even in a person having other allergies such as seasonal hay fever. Persistent gastrointestinal symptoms may indicate a much more serious problem and should be evaluated by a physician.

Insect sting allergy may hold greater danger for seniors. Although children may spontaneously lose a sensitivity to insects, this does not appear to hold true for adults. Additional stresses on the heart and cardiovascular system that occur with aging may make insect sting reactions more dangerous.

Seniors need to be concerned when allergies are present along with other illnesses. This requires careful investigation by the allergist and the primary care physician. Patients can help immensely in this communication by keeping all health care providers informed of changes in their conditions.

Management Requires Teamwork
Management of allergies and asthma in the senior patient requires the understanding and teamwork of the allergist and the primary care physician. These individuals must be aware of the effects of various medications as well as the possibility of drug interactions. A patient is advised to make a list of ALL medications and show it to physicians at each visit.

As one ages, certain health changes require additional medications. Some medications, such as beta-blockers, which are commonly used for high blood pressure and minor heart irregularities, may have a significant effect on the patient with asthma. These same medications may make the treatment of a severe allergic reaction more difficult, although they do not increase its chance of happening.

Medications
How medications work in the senior patient's body may also differ. It is sometimes necessary to use different forms of the same medication due to unrelated problems. Coexisting arthritis, for example, may make it difficult for a patient with asthma to use a hand-activated metered-dose inhaler. Using the inhaler may require a special adapter or an inhaler that does not require the patient to push down.

A nebulizer, a device used to deliver aerosolized medication, also may be less strenuous for the senior asthmatic and allow more of the medication to reach the airways. In other cases, it may be easier to swallow a liquid medicine than a pill if both are equally effective. Dosages of medication must sometimes be adjusted due to differences in seniors' metabolism of the medications or changes in sensitivity of the various organ systems. In addition, the amount of sleep a person gets can influence the effectiveness of medications. Sleep patterns may change with age, and asthma medications can further affect sleep patterns.

Although adults would be expected to know the importance of taking prescribed medication, people often have the tendency to try to minimize the amount of medications and avoid "putting chemicals into the body." Taking too little or too much of a prescribed medication may worsen asthma. This is especially important if the physician makes adjustments in medication, but is unaware that the patient is not properly taking the prescribed medications. To minimize the amount of medication required, it is better for a patient to work as a team with the physician to make certain that everyone understands the treatment goals, potential benefits and risks.

Other Therapies
Other non-medical aspects of therapy may help and should be explored with the guidance and awareness of the physician. Physical therapists, among others, can help seniors improve total body reflexes, and a safe exercise program can be arranged that will take into account coexisting problems such as osteoarthritis, high blood pressure or heart disease.

Establishing reasonable therapeutic goals and working as a team with various health care providers can help the senior patient with allergies and asthma achieve maximum benefit from treatment, with minimal negative side effects. A qualified allergist and the primary care physician, working as a team, can provide optimal medical care for the senior patient.

Your allergist can provide you with more information on asthma and allergies in seniors.

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