Asthma Management Handbook

Assessing and monitoring asthma control in older adults

Recommendations

As well as assessing asthma control and lung function, assess comorbidity, risk factors and psychosocial factors that may affect asthma control and self-management (e.g. poor eyesight, hearing loss, poor coordination, osteoarthritis, cognitive impairment and other mental health conditions).

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Review asthma regularly, as for younger adults. Consider:

  • recent asthma symptom control
  • risk factors for flare-ups, deterioration in lung function or treatment-related adverse effects
  • lung function
  • inhaler technique
  • adherence to medicines.
How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Special considerations for review of asthma in older adults

Patient-reported symptoms can underestimate the severity of asthma in older adults.1 Therefore, spirometry is necessary to measure lung function objectively.

Factors that can affect asthma control and self-management in older adults include comorbidity, chest infections, cognitive decline, social isolation, anxiety and depression, long-term smoking, obesity, dysfunctional breathing and exercise limitation.2 The cost of medicines may also prevent people taking preventers as directed. All these factors should be checked when reviewing asthma.

The risk of dying from asthma increases with age in Australian men and women.3 Approximately 60% of Australians who die from asthma are over 65 years old.4 Most people 65 years and older who experience acute asthma are not taking regular inhaled corticosteroid treatment.2

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Comorbidity in older adults

Many older people with asthma also have multiple comorbidities and complex healthcare needs.25 Common conditions in older people that may affect asthma control include:2

  • obesity
  • gastro-oesophageal reflux disease
  • obstructive sleep apnoea syndrome and other sleep disorders
  • osteoporosis (vertebral fractures can impair respiratory capacity)
  • cardiovascular disease (some medicines may worsen asthma).

The presence of diabetes can affect decisions about the use of systemic corticosteroids, while heart disease or anaemia can mimic symptoms.

There is limited clinical trial evidence to guide asthma management in older people with common comorbid conditions, because most asthma treatment trials have excluded people with these conditions.12 Guidelines for one disease condition may have to be modified for older people with multiple chronic diseases to avoid potential adverse effects including drug–drug interactions.2

Common age-related problems such as cognitive impairment, poor eyesight, hearing loss, poor coordination or osteoarthritis can affect a person’s ability to use inhaler devices correctly.

Medicare items for chronic disease management (e.g. GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans) apply to patients with asthma.

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References

  1. deShazo RD, Stupka JE. Asthma in US seniors: part 2. Treatment. Seeing through the glass darkly. Am J Med. 2009; 122: 109-13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19100959
  2. Gibson PG, McDonald VM, Marks GB. Asthma in older adults. Lancet. 2010; 376: 803-813. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20816547
  3. Australian Centre for Asthma Monitoring. Asthma in Australia 2011: with a focus chapter on chronic obstructive pulmonary disease. Asthma series no. 4. Cat. no ACM 22. Australian Institute of Health and Welfare, Canberra, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=10737420159
  4. Andrews KL, Jones SC. "We would have got it by now if we were going to get it ..." An analysis of asthma awareness and beliefs in older adults. Health Promot J Aust. 2009; 20: 146-150. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19642964
  5. Goeman DP, Douglass JA. Optimal management of asthma in elderly patients: strategies to improve adherence to recommended interventions. Drugs Aging. 2007; 24: 381-394. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17503895