Asthma Underdiagnosed and Undertreated in the Elderly

Asthma Underdiagnosed and Undertreated in the Elderly:Shortness of Breath May Not Be Simply Aging

ARLINGTON HEIGHTS, Ill. (May 16, 2001) - Asthma is a significant, chronic problem in the elderly, and is associated with higher prevalence of allergic sensitivity to indoor allergens than previously thought according to investigators. The report is published in this month's Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

"Our study included an examination of indoor allergens in the homes of elderly people with asthma and an analysis of their home environment characteristics," said Richard W. Huss, M.D., The Johns Hopkins University, Baltimore, Md. "We evaluated their allergy skin test reactions and asthma severity. Through validated questionnaires, we looked at how the severity of the disease contributed to reduced quality of life and health status."

Almost 75 percent of the 80 elderly participants tested positive to at least one airborne allergen. These study results contrast with findings of other investigators, where the presence of allergy in the elderly was thought to be low.

"Cat was the most prevalent positive skin test, and Bermuda grass was the second most common. More than half of the elderly participants were exposed to significant levels of house dust mites, and almost 30 percent were exposed to significant levels of cockroach allergens. These allergen levels were high enough to place people with asthma at risk of exacerbations," Dr. Huss said.

"Almost two-thirds of the elderly participants had moderate or severe persistent disease, and quality of life scores in these groups were significantly lower than those with mild asthma. The aspects of quality life we measured were activity limitations, symptoms, emotional function and environmental stimuli," he said.

Almost one-third of the participants were not taking inhaled steroids, considered the first line of treatment for long-term control of persistent asthma. Many were using quick-relief medications regularly, rather than only when needed.

"These findings support allergy skin testing for elderly subjects with asthma, especially for those with moderate to severe persistent severity. Test results are then used to recommend interventions to reduce allergens in the home," Dr. Huss said.

"The addition of medications that combat inflammation in the airways is also important. Long-standing asthma in the elderly often causes severe and persistent airflow obstruction. Treatment, however, may significantly improve this obstruction," he said.

Approximately 1.5 million people in the United States over age 65 have asthma, affecting an estimated 3.8 percent of elderly men and 7.1 percent of elderly women.

"Huss and colleagues point out the importance of diagnostic allergy testing when asthma is suspected in the elderly," said editorial author Raymond G. Slavin, M.D., Saint Louis University School of Medicine, St. Louis, Mo. "We must not glibly attribute shortness of breath to aging. We also have to keep in mind the distinct possibility of an allergic basis, particularly for moderate and severe persistent asthma in the elderly.

"As physicians, we owe these patients a careful history and appropriate skin testing. By identifying clinically significant allergens and then instituting appropriate environmental interventions, we can help make this time in our elderly patient's life truly the golden years," Dr. Slavin said.

The ACAAI is a professional medical organization comprised of 4,100 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

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Media Contact: Jo Ann Faber - (847) 427-1200 or [email protected]. Full-text articles published in Annals of Allergy, Asthma & Immunology are available at no charge online at www.annallergy.org until July 1, 2001.

Journal Reference:Huss K, et al. Asthma severity, atopic status, allergen exposure, and quality of life in elderly persons. Ann Allergy Asthma Immunol 2001; 86: 524-530.