For anyone with parents or grandparents well into their silver years, it is not uncommon to notice them experiencing frequent bouts of wheezing, coughing and even difficulty breathing. These symptoms are worrying, particularly in an older person, as they are often connected to chronic illnesses such as bronchitis. However, these symptoms can also be manifestations of asthma in the elderly and with the Singapore Institute of International Affairs (SIIA) has forecasted a “moderate risk” for severe haze to hit Singapore late this year, how can you recognise the symptoms of asthma in our loved ones and what can the elderly do to combat the haze?
Asthma in seniors
While asthma is commonly understood as an illness diagnosed during childhood, it is not uncommon for adults above 65 years old to develop asthma symptoms for the first time. Asthma is a chronic lung disease characterised by reversible airway obstruction, with variable and recurring symptoms of coughing at night, shortness of breath, wheezing and chest tightness. Common triggers of asthma include upper respiratory tract illness such as sore throat and the common cold, physical exercise, dust and air pollution. It is often also associated with atopy – the genetic tendency to develop allergic diseases, including eczema and allergic rhinitis. Globally, asthma affects about 10% of senior citizens aged 65 years and above. Since asthma is caused by an inflammation of the lungs, common vaccinations like the influenza vaccine can relieve symptoms as it builds one’s defences against the flu, which irritates and inflames the airway. However, the National Health Surveillance Survey in 2013 found that only 14% to 20% of Singaporeans above the age of 50 have been vaccinated against influenza. As Singapore’s rapidly ageing population, the number of elderly people with asthma will rise.
Elderly persons who suffer from asthma are more prone to emergency department visits and hospitalisations as compared to other adult cohorts. They also have higher mortality rates due to reduced lung reserves and associated co-morbidities.
For this reason, elderly with asthma should be particularly careful during periodic haze episodes in Singapore that can affect respiratory health due to their weaker lung function. During periods of haze, asthmatic elderly persons should minimise prolonged or strenuous outdoor physical exertion, especially when the Pollutants Standards Index (PSI) is above 100 or fine particulate matter (PM2.5) is elevated.
Asthma in elderly is frequently confused with another lung disease known as chronic obstructive pulmonary disease (COPD), due to similar symptoms such as shortness of breath, wheezing, and chest tightness. The main difference in these two conditions is that nearly all patients with COPD have a history of smoking, whereas asthma is not directly caused by smoking. However, the two can overlap if the elderly patient with asthma is also a heavy smoker.
Precautions for seniors with asthma
There are precautions that the elderly with asthma can take manage their condition and prevent complications. They should regularly follow up with their doctor and take their prescribed medications such as inhalers. Some elderly who may have difficulty with coordination would require a spacer to take the medication properly.
In addition, developing an “asthma action plan” with a doctor, keeping track of asthma control methods, avoiding triggers and being aware of worsening symptoms are important aspects of asthma management. Elderly patients with chronic lung disease should keep up to date with their vaccinations to protect against pneumococcal and influenza infections.
Family members also play an important role in encouraging and supporting their loved ones with asthma to manage their asthma, helping to ensure that the measures above are taken.
If not properly managed, asthma in seniors can be a potentially life-threatening and dangerous condition, especially in situations such as the haze period where air quality deteriorates and increases the likelihood of triggering asthma attacks. However, with the proper care and management plans, it is possible to avoid these life-threatening situations and live more comfortably.
Contributed by Dr Tan Kheng Liang, Family Physician, Silver Cross Clinic (Marsiling) [A Member of Healthway Medical Group]
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