Asthma control in older adults

Overview

Asthma is a long-term lung condition that causes the airways (tubes that carry air in and out of your lungs) to become swollen and narrow, making it harder to breathe. In older adults, asthma may be more complex because of other health conditions and changes in the lungs due to aging.

Asthma is common in older adults. Many people over 65 have asthma, and it is often underdiagnosed because symptoms can be mistaken for other conditions like chronic obstructive pulmonary disease (COPD) or heart problems.

Adults aged 65 and older, especially those who have had asthma for many years, have other long-term conditions (such as high blood pressure or diabetes), or have a history of smoking.

Symptoms

Common symptoms

• Wheezing (a whistling sound when you breathe)
• Shortness of breath
• Chest tightness or pain
• Coughing, especially at night or early in the morning

Symptoms in older adults

• Fatigue or feeling very tired
• Difficulty breathing during normal activities like walking or climbing stairs
• Confusion or dizziness because of low oxygen
• Symptoms that come and go, but may not be obvious as 'asthma'

Causes

Main causes

• Allergens such as pollen, dust mites, or pet dander
• Irritants like cigarette smoke, strong odors, or air pollution
• Respiratory infections (colds, flu, or COVID-19)
• Weather changes (cold air or humidity)
• Exercise or physical activity
• Stress or strong emotions

Risk factors

• Age over 65
• Smoking or past smoking
• Being overweight or obese
• Family history of asthma or allergies
• Other health conditions such as acid reflux or sleep apnea
• Working with dust, chemicals, or fumes in the past

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call emergency services right away.
• If your asthma symptoms are getting worse quickly or you need to use your reliever inhaler more often than usual, see your doctor within the day.

Book a routine appointment if:

• If you have mild or moderate symptoms that affect your daily life but are not urgent, schedule a routine appointment.
• If you need a medication review or help with your inhaler technique.
• If you have not seen a doctor for your asthma in the past year.

Diagnosis

Your doctor will ask about your symptoms, medical history, and family history. They will listen to your breathing and may order tests to measure how well your lungs work.

Tests that may be done

• Spirometry: You blow into a machine to measure how much air you can breathe out and how fast.
• Peak flow monitoring: A small device measures how quickly you can blow air out. Low readings may indicate asthma.
• Allergy tests: Skin or blood tests to check for allergens that may trigger symptoms.
• Trial of asthma medications: If your symptoms get better with inhalers, it supports the diagnosis.

What to expect at your appointment

The doctor will talk with you about your symptoms and go through the tests. It may take more than one visit to be sure of the diagnosis, especially if you have other health conditions. They will also check for conditions like COPD that can look like asthma.

Treatment

Treatment for asthma focuses on controlling symptoms and preventing attacks. Most people use two types of inhalers: a reliever (for quick relief when symptoms happen) and a controller (taken every day to reduce airway swelling). Your doctor will work with you to find the best approach.

Self-care at home

• Know and avoid your asthma triggers (like smoke, dust, or pollen).
• Use your inhalers exactly as prescribed – even when you feel well.
• Learn the correct inhaler technique – ask your doctor or nurse to show you.
• Have a written asthma action plan that tells you what to do when symptoms get worse.
• Monitor your peak flow at home and keep a symptom diary.

Medical treatments

Your doctor may prescribe controller inhalers that you use daily to prevent inflammation, and reliever inhalers for sudden symptoms. In some cases, other treatments such as tablets or injections may be added if asthma is hard to control. Always follow your doctor's advice and never change doses without consulting them.

When is surgery considered?

Not relevant for asthma alone, but if you have surgery for another reason, tell your anaesthetist about your asthma so they can manage your breathing during the operation.

Living with this condition

Asthma does not have to stop you from doing what you love. Keep your home clean and free from dust, avoid cigarette smoke, and get vaccinated against flu and pneumonia. Make sure you always have your reliever inhaler with you.

Lifestyle tips

• Stay physically active – walking, swimming, or gentle exercise can help your lungs.
• Practice deep breathing or relaxation techniques to manage stress.
• Get enough sleep and keep a regular routine.
• Avoid spending time outdoors when pollen or air pollution is high.

Diet and exercise

Eat a healthy, balanced diet with plenty of fruits, vegetables, and whole grains. Maintaining a healthy weight can help your lungs work better. Exercise is good for asthma – ask your doctor which activities are safe for you.

Mental health and emotional wellbeing

Living with a chronic condition like asthma can sometimes cause anxiety, stress, or depression. Talking to a mental health professional, joining a support group, or simply sharing your feelings with family can help.

Prevention

Asthma itself cannot be prevented, but you can prevent asthma attacks by keeping good control. Avoid triggers, take your medication as prescribed, and get routine checkups.

Vaccines

Get the flu vaccine every year and ask your doctor about the pneumonia vaccine. These help prevent respiratory infections that can make asthma worse.

Screening programmes

Routine checkups with your doctor are important. You do not need regular asthma screening if you do not have symptoms, but if you notice new breathing problems, see your doctor.

Complications

If left untreated

• More frequent and severe asthma attacks
• Permanent damage to the airways (lung scarring)
• Hospitalization
• Reduced ability to do daily activities
• Poor quality of life

Long-term outlook

With the right treatment and self-care, most older adults with asthma can control their symptoms and live a full, active life. Even if your asthma is severe, good teamwork with your doctor can make a big difference.

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