Do You Have Asthma?

Find out who's at risk.

WebMD Feature

June 19, 2000 -- Having had a daughter and an ex-husband with asthma, Marjorie Malloy of Los Angeles was well informed about the disease. She just never expected to contract it herself, especially well into adulthood.

When her symptoms started more than a dozen years ago, she attributed them to almost everything but asthma. "At first I thought it was bronchitis, because I was getting over a bad cold," says Malloy, a grandmother who won't tell her exact age. "I also considered it might be allergies. I was shocked when the doctor said it was asthma. I thought, 'Where did this come from at my age?' "

While many people tend to characterize asthma as a childhood disease, it can persist throughout life and, as in Malloy's case, can even develop later in life.

A Growing Problem

The number of people with asthma in the United States has more than doubled from 1980 to 1998, according to the Centers for Disease Control and Prevention (CDC), rising from 6.7 million to 17.3 million. And while the problem of childhood asthma is well publicized, the problem of adult asthma, including asthma in the elderly, is not as well known. Yet about 10% of those in the United States with asthma are age 65 and above, the CDC estimates.

The actual number, some experts believe, may be much higher. In a report published in the September 1999 issue of Chest, the journal of the American College of Chest Physicians, researchers found that asthma is going undiagnosed and is undertreated in the elderly. They based the findings on a study of 2,527 seniors, aged 65 and older, including 4% who had a current diagnosis of asthma and another 4% who reported symptoms of asthma during the past year but had not been given a diagnosis of asthma. (To find out more about asthma in adults, see What Is Asthma in Adults?)

Why Seniors Develop Asthma

Researchers aren't certain why asthma is on the rise in the population of older people. They do know some seniors who get asthma had it as children and thought they had outgrown it. But experts now realize that asthma does not typically go away entirely.

The rise in the prevalence of asthma in seniors may also be a matter of their prolonged exposure to environmental substances that cause inflammation in the lungs -- such as smoke and pollutants. Jacob Offenberger, MD, medical advisory chair of the Asthma and Allergy Foundation of Southern California, notes that people are living longer and, as a result, have greater exposure to a wider variety of allergens over a longer period of time. In addition, respiratory tract infections, which tend to be more persistent in older patients, can also predispose people to asthma.

Diagnostic Challenges

Identifying asthma in the elderly can be difficult because the effects of aging and other health problems may mask the disease.

Asthma symptoms often take the form of coughing and the production of sputum from the lungs, which initially might be mistaken by physicians as chronic bronchitis or congestive heart failure, according to Offenberger. Furthermore, patients themselves may dismiss their symptoms, chalking up breathlessness as a normal effect of aging, for instance.

"A lot of people assume that if you're old and you cough, you have emphysema," says Offenberger, who sees many patients after they have been incorrectly diagnosed and their prescribed treatment is not working.

Asthma in younger persons is often detected by symptoms of wheezing and breathing problems during and after exercise. But because many seniors lead inactive lifestyles, such symptoms are less likely to be obvious.

Treatment Options

Medical management of asthma in seniors is similar to that for younger asthmatics. They are instructed to avoid allergens like pollen and animal dander and irritants such as smoke. Medications and allergy injections are sometimes effective. Long-term or "controller" medications delivered by inhaler are often prescribed to relieve the underlying inflammation in the airways. So-called rescue medications, also delivered by inhaler, are used to alleviate symptoms of attacks or flare-ups.

Unfortunately, some medications taken to treat other illnesses can worsen asthma. (Included on the list are aspirin and other anti-inflammatory medications used to treat arthritis and other pain, and beta-blocking agents for hypertension, heart disease, and glaucoma.) Therefore, good communication between seniors and their physicians about any medications they may be taking (and about other medical conditions they have) is critical.

The good news is that once correctly diagnosed, sufferers of adult-onset asthma can still get significant relief for their symptoms and improve lung function if they take their medicines faithfully, says Offenberger. "The tendency is not to take the medicine if you feel well, but you have to take it every day regardless of how you feel."

Today, with the help of daily medication, Malloy leads a fairly active life. Besides pampering her grandson, she keeps busy volunteering at the Asthma and Allergy Foundation on a regular basis.

Melba Newsome is a journalist based in Matthews, N.C., whose work has appeared in Family Circle, Essence, and Cosmopolitan magazines.

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