Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly

Abstract

The prevalence of asthma in the most advanced ages is similar to that of younger ages. However, the concept that older individuals may suffer from allergic asthma has been largely denied in the past, and a common belief attributes to asthma the definition of “rare” disease. Indeed, asthma in the elderly is often underdiagnosed or diagnosed as COPD, thus leading to undertreatment of improper treatment. This is also due to the heterogeneity of clinical and functional presentations of geriatric asthma, including the partial loss of reversibility and the lower occurrence of the allergic component in this age range. The older asthmatic patients are also characterized the coexistence of comorbid conditions that, in conjunction with age-associated structural and functional changes of the lung, may contribute to complicate the management of asthma. The current review addresses the main issues related to the management of allergic asthma in the geriatric age. In particular, the paper aims at revising current pharmacological and non pharmacological treatments for allergic asthmatics of advanced ages, primarily focusing on their safety and efficacy, although most behaviors are an arbitrary extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. Experimental studies and real life observations specifically testing the efficacy and safety of therapeutic approaches in allergic asthma in the elderly are urgently needed.

Evaluation of asthma control in the pharmacy: an Italian cross-sectional study

“…Of note, in our study population, around one out of three patients (27.6%) was older than 65 years. As highlighted by other reports (28,29) asthma in the elderly is not a rare disease, and its detection and management in that specific population deserves the highest consideration. Furthermore, the treatment choices should be carefully evaluated was prevalent (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

The Effect of Nebulized Salbutamol on Serum Potassium and Blood Sugar Level of Asthmatic Patients

“…Seventy five deaths of asthmatic patients in a recent study using home nebulizers were reported, 16-30% of them had delay in seeking help, because of over reliance on high doses of salbutamol. The exact mechanism of death in such cases is unknown, but has been postulated to be due to fatal cardiac arrhythmias induce by hypoxia (Holt, 2007), an alternative hypothesis is that inhalation of high dose beta2-agonist induced hypokalemia may further aggravated by the acute stress of the illness and by concomitant corticosteroids or theophylline therapy, so accurate detection of this side effect is useful (Scichilone et al, 2015). There are several studies that demonstrate a statistically significant decrease in serum potassium and magnesium after β2AR agonists administration.…”

Role of Antileukotriene Drugs in Achievement of Bronchial Asthma Control

“…Было показано, что АЛП безопасны у пожилых пациентов с БА, хотя описаны единичные случаи острого гепатита и возникновения синдрома Чардж -Стросса. Остается открытым вопрос, являются ли эти реакции случайными и связаны ли они с возрастом [53].…”