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Communications to the Editor |

Bronchial Asthma in the Very Elderly FREE TO VIEW

Katsunori Kagohashi, MD; Hiroaki Satoh, MD; Kiyohisa Sekizawa, MD
Author and Funding Information

University of Tsukuba Tsukuba City, Japan

Correspondence to: Hiroaki Satoh, MD, Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, 305-8575, Japan; e-mail: hirosato@md.tsukuba.ac.jp



Chest. 2002;122(4):1501. doi:10.1378/chest.122.4.1501
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Published online

To the Editor:

Bronchial asthma (BA) is not rare in the elderly and causes significant morbidity and mortality.12 BA beginning after the age of 50 years is more severe and less reversible than asthma in children.3 We reviewed the clinical features and management of six patients ≥ 80 years old with BA diagnosed in our hospital over the past 10 years (mean age, 87 years; range, 80 to 97 years). Four patients had a history of cardiovascular disease, and one patient had a history of cerebrovascular disease. The bronchodilator inhalation test at ≥ 80 years of age resulted in a 16.0 to 43.2% (mean, 26.9%) increase in FEV1. Five patients received oral β2-agonists, and four patients received oral theophylline. At the time of exacerbation of BA in one patient, theophylline was administrated IV and the serum theophylline level was temporarily elevated to the toxic range. This toxicity might be due to the simultaneous administration of oral quinolone antibiotics. Five patients received inhaled steroids; however, in one patient steroid inhaler was not prescribed because of poor adherence to aerosol because of its odor.

We showed that in patients ≥ 80 years old, BA continues to have significant reversibility. The treatment of such patients is further complicated by concomitant disease and pharmacologic interactions, and thus elderly people may not receive optimal treatment for BA.23 In the presence of coronary artery diseases, hypoxemia due to asthma and cardiac side effects from β2-agonists and theophylline may amplify the morbidity in elderly patients.,1,4Side effects from excessive β2-agonists and theophylline should be avoided by careful monitoring of symptoms and drug levels in patients at risk of heart disease.5 Additionally, inhaler technique can be a particular problem in elderly patients with BA; however, inhaled steroid is safe and effective, and is indicated especially elderly asthmatics without fear of severe complications. The choice of an appropriate treatment for elderly patients with BA needs careful consideration of the severity of the disease and coexisting diseases, and the level of treatment required.

Jack, CI, Lye, M (1996) Asthma in the elderly patients.Gerontology42,61-68. [PubMed] [CrossRef]
 
Enright, PL, McClelland, RL, Newman, AB, et al Underdiagnosis and undertreatment of asthma in the elderly.Chest1999;116,603-613. [PubMed]
 
Reed, CE The natural history of asthma in adults: the problem of irreversibility.J Allergy Clin Immunol1999;103,539-547. [PubMed]
 
Schiff, GD, Hegde, HK, LaCloche, L, et al Inpatient theophylline toxicity: preventable factors.Ann Intern Med1991;114,748-753. [PubMed]
 
Fowler, JB Medication monitoring in the elderly.Clin Lab Sci1995;8,34-38. [PubMed]
 

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References

Jack, CI, Lye, M (1996) Asthma in the elderly patients.Gerontology42,61-68. [PubMed] [CrossRef]
 
Enright, PL, McClelland, RL, Newman, AB, et al Underdiagnosis and undertreatment of asthma in the elderly.Chest1999;116,603-613. [PubMed]
 
Reed, CE The natural history of asthma in adults: the problem of irreversibility.J Allergy Clin Immunol1999;103,539-547. [PubMed]
 
Schiff, GD, Hegde, HK, LaCloche, L, et al Inpatient theophylline toxicity: preventable factors.Ann Intern Med1991;114,748-753. [PubMed]
 
Fowler, JB Medication monitoring in the elderly.Clin Lab Sci1995;8,34-38. [PubMed]
 
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