Benefits of Inhalation Therapy for Asthma in Elderly Patients

Introduction

Asthma is a lung disease that narrows the airways and causes difficulty in breathing, triggers cough, and may interfere with daily activities. It is a major cause of the global increase in morbidity and mortality and may be a significant burden not only to the patients but also to their families. Asthma is commonly seen in elderly individuals above 65 years of age but can affect people of any age. Asthma cannot be cured, but the symptoms can be controlled.

How Is Asthma Different in Elderly People?

Most individuals experience the initial symptoms of asthma at a young age. Some elderly people may develop symptoms of asthma at the age of 70 or 80, which may even lead to respiratory failure. The respiratory muscle strength decreases with age, and rigidity of the chest wall contributes to the development of asthma. Poor immunity in elderly people can also lead to increased susceptibility to respiratory infections and a higher rate of sensitization which may result in asthma and also worsen the quality of life. Patients with chronic obstructive pulmonary disease (COPD) may also suffer from asthma which may be due to underlying pathogenic mechanisms like airflow obstruction.

What Are the Causes of Asthma?

The common causes of asthma in older adults include:

• Respiratory infections such as pneumonia, influenza, etc.

• Allergens and irritants.

• Air pollution.

• Medical conditions such as gastroesophageal reflux, and rhinosinusitis, may also trigger asthma.

What Are the Signs and Symptoms of Asthma?

Signs and symptoms of asthma include:

• Coughing.

• Wheezing.

• Shortness of breath.

• Chest pain.

• Disturbed sleep due to coughing or wheezing.

• Symptoms may worsen due to cold weather, physical exercises, tobacco smoke or airborne substances such as dust, pollen, dander of pets, mold spores, perfumes, etc.

How Is Asthma Diagnosed?

A physical examination is performed after recording the complete medical history of the patient, including family history, signs, and symptoms. Diagnostic tests performed to diagnose asthma include:

• Spirometry: The narrowing of the bronchial tubes can be checked by this test when the patient is asked to exhale after a deep breath and how fast it can be breathed out.

• Peak Flow: It is a device to check how hard the patient can breathe out; lower than usual peak flow readings may indicate the worsening of asthma.

• Lung Function Tests: These tests determine how well the lungs work.

• Imaging Tests: Such as chest X-ray helps to identify any structural abnormalities or diseases of the respiratory system.

• Allergy testing.

How Can Asthma Be Managed?

The therapeutic goalis mainly to reduce the severity and frequency of exacerbations in asthma. Treatment includes drugs that are delivered through an inhaler to achieve better control over the symptoms, which also improves the exercise tolerance and overall health of the patient. The prevention of triggering factors also plays an important role in the control of symptoms of asthma. The right medications with appropriate techniques reduce the inflammation of the airways. Quick inhalers immediately open the swollen airways and provide relief, but long-term medications such as inhaled corticosteroids and leukotriene modifiers keep control of asthma on a daily basis and prevent its aggravation.

What Is Inhalation Therapy for Asthma?

Inhalation therapy facilitates the direct administration of the drugs into the airways and plays an important role in the management of COPD and asthma as it provides immediate symptomatic relief to the patient. Inhaled medications are a combination of corticosteroids and bronchodilators, such as Fluticasone and Salmeterol, Mometasone and Formoterol, Budesonide and Formoterol, etc. The device factors like the type and complexity of its use, and patient factors such as cognitive function, vision, power of hands, motor skills, and proper training may influence the effectiveness of the therapy.

What Are the Benefits of Inhalation Therapy for Asthma in Elderly Patients?

The inhalers deliver medicines in sufficient quantities all across the lungs, including the peripheral areas. These medicines can either be rescue therapy when the symptoms worsen acutely. Although a large number of fixed-dose combination medicines are available, the disease often is challenging to control, especially in elderly patients. The adherence can be improved by providing adequate education and support to the patients regarding the proper use of inhaler techniques.

• Pressurized metered dose inhalers (pMDI) were the first to be introduced in the market in the 1950s, and it delivers aerosols that are finely divided with a size of fewer than five micrometers. The propellant used was hydrofluoroalkane (HFA), which had a lower impact force, and the temperature of the aerosol was warmer. As pMDI is portable in nature, they are very useful to deliver even in situations of emergency. It has been demonstrated that most types of inhalers are comparable in their efficacy, but the inhalation techniques make the difference. It efficiently emits the required dose of the inhaler when shaken well and needs slow deep breaths in comparison to dry powder inhalers.

• To overcome the coordination needed between respiration and inhalers to deliver an adequate quantity of medicines, spacers or chambers with inspiratory valves one-way have been introduced. This device helps in the proper dispersion of aerosolized medications. This device is particularly helpful in elderly individuals having poor coordination between hand and mouth. But due to their large size, they add bulk to store, transport, and more time is required in assembling the device.

• Dry powder inhalers (DPIs) were introduced in 1967; it is activated by the patient inspiration instead of a propellent as in pMDI. The powdered formulation of the drug (one to five µm in size) is paired with lactose (inactive carrier); based on the shear force generated by the inspiration of the patient, the drug separates from the inactive carrier leading to the dispersion of medication. SMIs are the newest in the block, which function similarly to nebulizers but they are portable and convenient to use.

Conclusion

Asthma is a chronic obstructive lung disease characterized by difficulty in breathing, chest pain, and coughing, and the symptoms worsen with exposure to cold or dry weather, pollution, and allergens. Despite the various treatment options, management of asthma is quite challenging in elderly people; with the use of specific inhalation devices such as pressured metered dose inhalers, with appropriate techniques, asthma can be addressed under control.