Common Respiratory Issues in Older Adults FAQ

1A. Is asthma treated in older adults the same way it’s treated in children and young adults?

Asthma can occur at any age. Older adults experience asthma, but are more likely to be underdiagnosed and undertreated. The CDC estimates that over 2 million persons 65 years old or greater have asthma, which is expected to rise to greater than 5 million by 2030.

Asthma in the elderly is complicated by the fact that they have an aging immune system’s response to inflammation, the hallmark of asthma. They are also at an increased risk of lower respiratory tract infections, which are a known trigger for asthma attacks, and their respiratory muscles and chest wall have less elastic recoil and increased weakness with aging.

In the elderly, and at any age for that matter, treatment should be focused on prevention and controlling symptoms. Avoiding asthma triggers such as pollen, animal dander, dust (if
allergic), air pollution, cigarette and wood-burning smoke, and certain medications such as aspirin, NSAIDs, and beta blockers is very effective prevention.

Staying up-to-date on vaccinations, including flu and pneumococcal vaccines, as well as vaccination for COVID-19, is very important.

The treatment of asthma in the elderly is similar to any age group: symptom control and preventing triggers. Typically, a combination of short-acting “rescue” inhaled bronchodilators, long-acting bronchodilators, and inhaled corticosteroids (if needed) provide good symptom control. Occasionally, a short course of oral corticosteroids is required for flare-ups. With some older asthmatics, spacers used with inhalers, powdered-type medication inhalers, and nebulized medications provide greater ease of use.

1B. Are there any complications specific to asthma as an older adult?

The elderly are more likely to develop respiratory failure as a complication of their asthma due to flare-ups. Also, asthma in older adults is less likely to go into remission and more likely to remain in a potentially serious disease state.

2. How does the flu affect older adults differently than younger ones?

Serious flu and flu-related complications such as pneumonia and increased hospitalization place older adults at higher risk. In those 65 and older, during the first few weeks of infection, flu also increases the risk of stroke and heart attack by 3 to 5 times.

3. What are some of the treatment options for COPD?

The best treatment options for COPD are inhaled short- and long-acting bronchodilators, as well as inhaled corticosteroids and treatment of suspected bacterial infections with antibiotics. Occasionally, a short course of oral corticosteroids for exacerbations may be needed. For those with more severe forms of COPD, oxygen therapy and pulmonary rehabilitation prove beneficial.

For a small percentage of people with the most severe cases of COPD, there are a few beneficial surgical options reserved.

4. How can older adults protect themselves from things like pneumonia becoming very serious?

Older adults can take steps to prevent pneumonia and its more serious complications by getting the pneumonia vaccine at age 65, as well as the influenza vaccine every year, since pneumonia can be a complication of the flu.

Avoiding cigarette smoke, which can damage the lungs and complicate effective treatment of
lower respiratory tract infections such as pneumonia, is essential.

It also proves beneficial to maintain a good diet, avoid infections with good hand hygiene, and enhance your immune system with regular exercise and good quality sleep.

5. What are some of the challenges of treating respiratory conditions in older adults?

Due to already-existing medical conditions – which could mimic an underlying primary pulmonary disorder – accurate and early diagnosis in the elderly can prove challenging.

Proper use of inhalers can also be challenging, which may necessitate the use of nebulized medications.

Another challenge is acute respiratory failure and the potential for postoperative respiratory complications such as pneumonia and acute hypoxemia in the elderly triggered by pneumonia or influenza. These occur in up to 50% of older adults and are associated with increased length of hospital stay and higher risk of long-term mortality.

6. How can adults work to keep their lungs healthy as they age?

Most importantly, stop cigarette smoking. Avoid second-hand smoke and air pollution. Start a regular exercise program such as walking combined with resistance (muscle) strengthening/training. Even if you develop active lung disease, exercise helps to slow the progression and keeps you active longer.

Stay up-to-date with vaccinations (pneumococcal and flu) and avoid infections with good hand hygiene.

Do deep-breathing exercises 2 to 5 minutes several times per day. By counting, slowly breathe in through your nose, then breathe out through your mouth at least twice as long. This also relaxes you and makes you feel less stressed.