Asthma at 60
DEAR DR. ROACH:: I am a fit and healthy 60-year-old male. Recently I was troubled by a series of escalating symptoms: I occasionally got a bit of hoarseness, then I seemed to lose some capacity in my lungs. When breathing hard, it seemed I could bring air into only the top of my lungs, not take a deep breath.
I then began wheezing when exerting myself, and my throat and chest began to feel mild pressure, like someone was gently pushing on them. My energy was low.
The wheezing and hoarseness continued, and I went to my doctor. He ordered an X-ray of my chest and sinus, which were normal.
We agreed that I would try a bronchodilator (Salbutamol). One puff after a slightly wheezing walk uphill gave me immediate relief. I felt like my old self again, and my voice returned to normal.
But the symptoms came back the next day. I used another puff, which opened my airways enough that I had a great bike ride home. Despite the success of the Salbutamol, I would like to get to the source of the breathing difficulties, not just treat the symptoms. I have an appointment with a specialist for lung function tests. Do you have any suggestions or advice?
ANSWER: It sounds very much like you have asthma. Many people are under the mistaken impression that asthma comes on only during childhood or adolescence, but it is just as likely to do so in a person’s 60s. As far as understanding the underlying cause, that is beyond medical science right now. However, we do know a lot about the underlying inflammation that is associated with asthma.
What I can say is that after the diagnosis is confirmed, probably by the lung function tests showing airway obstruction that is reversible with treatment, you may need an anti-inflammatory, such as an inhaled steroid. This is appropriate therapy for most people with asthma that is more than intermittent and mild.
DEAR DR. ROACH: My son is 51 years of age, and apparently in good health. He had chickenpox as a young child. My concern is whether he should get the shingles vaccination now, or wait until he is older.
I have heard that the vaccine wears off as you get older, and I wonder if he should wait until he is older and hope he does not get the shingles earlier.
ANSWER: I recommend waiting until 60. The shingles vaccine becomes more important as people get older, partially because the vaccine wears off, but mostly because shingles is worse in older people. In particular, the likelihood of getting severe post-herpetic neuralgia, the pain syndrome that can follow shingles, is higher, and when it does, it lasts longer in older people.
That’s why expert groups recommend getting the vaccine at age 60. A new vaccine in development hopefully will be longer-lasting and more effective.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.