Perception of Bronchoconstriction in Elderly Asthmatics

Department of Chest Diseases, Faculty of Medicine, Kirikkale University, Turkey.
Journal of Asthma (Impact Factor: 1.8). 12/2001; 38(8):691-6. DOI: 10.1081/JAS-100107547
Source: PubMed


The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37, group 2, > or = 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, > or = 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 +/- 0.17; group 2, PS20 = 1.37 +/- 0.12, p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (IA, 2.63 +/- 0.30 and IB, 2.07 +/- 0.16, p = 0.101; 2A, 1.36 +/- 0.19 and 2B, 1.59 +/- 0.120, p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and % FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.

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    • "Older asthmatics seem to complain less about their symptoms, and Connolly et al5 demonstrated that elderly patients were less aware of experimentally induced bronchoconstriction than younger controls. This observation was confirmed by other studies,6,7 supporting the notion that elderly asthmatics can be considered “poor perceivers” of their symptoms. From a clinical perspective, asthma maintains its clinical characteristics in the elderly, although some overlap with features of chronic obstructive pulmonary disease may occur as the patient ages. "
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    ABSTRACT: Asthma is a disease of all ages. This assumption has been challenged in the past, because of several cultural and scientific biases. A large body of evidence has accumulated in recent years to confirm that the prevalence of asthma in the most advanced ages is similar to that in younger ages. Asthma in the elderly may show similar functional and clinical characteristics to that occurring in young adults, although the frequent coexistence of comorbid conditions in older patients, together with age-associated changes in the human lung, may lead to more severe forms of the disease. Management of asthma in the elderly follows specific guidelines that apply to all ages, although most behaviors are pure extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. This review focuses specifically on the safety and efficacy of leukotriene modifiers, which represent a valid option in the treatment of allergic asthma, both as an alternative to first-line drugs and as add-on treatment to inhaled corticosteroids. Available studies specifically addressing the role of montelukast in the elderly are scarce; however, leukotriene modifiers have been demonstrated to be safe in this age group, even though cases of acute hepatitis and occurrence of Churg-Strauss syndrome have been described in elderly patients; whether this is associated with age is to be confirmed. Furthermore, leukotriene modifiers provide additional benefit when added to regular maintenance therapy, not differently from young asthmatics. In elderly patients, the simpler route of administration of leukotriene modifiers, compared with the inhaled agents, could represent a more effective strategy in improving the outcomes of asthma therapy, given that unintentional nonadherence with inhalation therapy represents a complex problem that may lead to significant impairment of asthma symptom control.
    Full-text · Article · Oct 2013 · Clinical Interventions in Aging
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    • "Connolly et al. [11] demonstrated that elderly asthmatics have a reduced awareness of acute bronchoconstriction following a methacholine challenge compared to younger asthmatics patients. Further, Ekici et al. [12] performed an airway challenge on an asthmatic population. Elderly asthmatics reported less breathlessness on Borg dyspnoea score compared to the young asthmatics for a comparable level of bronchoconstriction. "
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    ABSTRACT: As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological factors. Medication strategies for asthma have been dominantly derived from younger cohorts so that effective medication strategies have usually not been explored in older people. Older people with asthma are very concerned regarding side effects of medication so that adherence to therapeutic regimes is often poor. In addition physical disability can lead to difficulty in accessing treatment and using inhaler devices. Practical strategies to improve asthma outcomes in older people have been studied infrequently and the goals of self-management suitable for younger age-groups may not be applicable in this group. Consequently, asthma in older people is deserving of further attention both to basic mechanisms of disease, precision in diagnosis and effective therapeutic strategies, including those that involve self-management and device use.
    Full-text · Article · Apr 2012
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    • "In addition , long-term adaptation to breathlessness may change the frame of reference [23]. Reduced perception of bronchoconstriction has been reported in the elderly [17] [18] [24], in patients with chronic obstruction [11] [25], in patients with frequent airflow variation [11] and long duration of the disease [20]. Patients in group B were older than those in group A and it is reasonable to assume that they had had their asthma for a longer time which may have contributed to a reduced perception of symptoms . "
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    ABSTRACT: To find out whether symptom-free asthmatic patients with impaired lung function, improve with regard to quality of life after treatment adjustment. Forty-two primary care asthma patients without symptoms were divided into two groups: (A) with normal lung function (n=22); and (B) with impaired lung function (n=20). Lung function, symptoms and quality of life were assessed before and after a 3-month interval. In group B (but not in group A), treatment was adjusted on the first visit. Quality of life was significantly worse in group B at visit 1 and was improved up to the same level as in group A after 3 months of treatment adjustment. Quality of life did not change in group A during the 3 months of observation. Lung function improved significantly only in group B but did not reach the same level as in group A. Adjustment of therapy improves quality of life even in patients who do not experience symptoms. Asthma treatment should therefore be guided by both symptoms and lung function.
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