Adult Asthma: Symptoms, Triggers and Outcomes

Mike is a 76-year-old gentleman who lives alone in a single-family home in Arizona. He has recently recovered from COVID-19. He has a long history of asthma. Prior to his recent hospitalization, he could care for himself. However, Mike is finding managing his oxygen and medications more challenging as he continues to struggle with breathing issues.

Prior to his discharge from the hospital, Mike was evaluated by physical therapists. He was taught breathing exercises to help with his asthma and exercises to improve his balance and stability while walking. He finds it difficult to manage these exercises on his own.

Mike does not have family in the area. He was offered admission into a rehabilitation center or skilled nursing facility, but he declined. He prefers to be at home.

What is asthma?

Asthma is a chronic lung disease characterized by a dry cough and wheezing. Spasms in the airway and increased mucus production cause wheezing as air is pushed through narrow breathing tubes.

Difficulty moving air into and out of the lungs leads to shortness of breath and a feeling of chest tightness. Many people with asthma develop a cough due to their irritated airways.

The classic symptoms of asthma are:

• Wheezing
• Chest tightness
• Shortness of breath
• Cough

There is no cure for asthma. However, the symptoms can be managed. One strategy to manage asthma is to avoid your triggers.

Common asthma triggers include:

• Allergens such as dust mites, cockroaches, pollen, mold, and pet dander
• Pollution
• Weather changes, especially dry, cold air
• Smoke
• Dust
• Exercise
• Stress and strong emotions
• Viruses
• Medications such as aspirin, non-steroidal anti-inflammatory drugs, and beta-blockers
• Hormonal changes

What are the types of asthma?

The typical symptoms of asthma are consistent across all types. However, asthma can be divided into the following categories:

• Allergic asthma
• Non-allergic asthma
• Exercise-induced bronchospasm (EIB)
• Cough-variant asthma
• Nocturnal asthma
• Adult-onset asthma
• Pediatric asthma

Adult asthma

Adults in their 70s and 80s can be diagnosed with asthma for the first time. Because older adults are more likely to have other chronic health conditions, making the diagnosis can be more difficult. The productive cough associated with adult-onset asthma is commonly interpreted as chronic bronchitis or even congestive heart failure.

Compared to asthma that develops during childhood, adult-onset asthma is more likely to:

• Be constant with few periods of remission
• Lead to a more rapid decline in lung function
• Be more difficult to treat
• Be less likely due to allergies

Mike has a 30-year history of smoking and was diagnosed with asthma as a child. He quit smoking ten years ago. Mike uses a rescue inhaler at least twice a week and uses a steroid inhaler daily. His triggers are stress, smoke, and cold air. His asthma was reasonably well-controlled until he contracted COVID-19. Now he uses an aerosol machine three times per day to deliver his bronchodilator, takes oral corticosteroids, and is on home oxygen therapy.

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What are the most common complications of chronic asthma in older adults?

Asthma in older adults is largely underdiagnosed and misdiagnosed, which means that it is often under-treated. Unfortunately, many people, patients and healthcare providers alike, think of asthma as a childhood disease and jump to a diagnosis of COPD or congestive heart failure.

If asthma is not treated, it can cause airway and lung damage. Scarring in the lungs makes it more difficult to treat asthma symptoms and improve airflow.

Does asthma get worse as you get older?

Yes, with age, the elastic fibers in the lungs tend to stiffen, the chest wall becomes more rigid, and the respiratory muscles weaken. This combination of factors exacerbates the shortness of breath and chest tightness that are classic asthma symptoms.

The immune system also ages and becomes less effective at fighting off infections, a phenomenon called immunosenescence. The number of chronic illnesses an individual has also tends to increase with age, which brings increased inflammation. Medications that may have worked in the past, may no longer work as well. Older adults should carefully monitor their respiratory status and work with their doctor to keep their symptoms under control.

Is COPD different from asthma?

Chronic obstructive lung disease (COPD) is a chronic, progressive, irreversible lung disease that is usually due to damage to the airways from smoking. Asthma is a reversible lung disease due to inflammation. The exact cause of asthma is unknown, but it seems to be a combination of genetic and environmental factors.

Chest tightness, shortness of breath, wheezing, and cough are symptoms found in both COPD and asthma. It is possible to have both asthma and COPD, a condition called Asthma-COPD overlap or ACO. Those who have asthma that is poorly controlled and who smoke are more likely to develop ACO.

Does adult asthma shorten your lifespan?

There is a wide range of asthma severity, from mild to severe and uncontrolled. Several studies have shown that in those with asthma who are not smokers and who do not have chronic lung disease, asthma does not significantly shorten their lifespan.

Researchers from Copenhagen found that compared to people who never smoked, lifespan was

• 3 years shorter in those who had asthma and COPD with early-onset asthma
• 8 years shorter in those who had asthma and COPD with late-onset asthma
• 1 year shorter in those who had COPD only
• 3 years shorter in those who had asthma only

According to the Centers for Disease Control and Prevention, the rate of asthma deaths declined from 15 per million in 2001 to 10 per million in 2016. However, adults were five times more likely to die from asthma than children. The highest death rate is in adults over the age of 65. Females are at higher risk of dying from asthma than males, and non-Hispanic Black people have an asthma death rate two to three times that of other races.

Mike contacted Sunland Home Care & Medical to arrange weekly home nursing visits and daily home care visits.  A Sunland private duty nurse will come weekly or as needed to check his medical equipment, do a wellness check, assess his fall risk, and accompany him to his medical appointments. Caregivers will help Mike complete his exercises. They will also prepare his meals and assist with housekeeping.