Living with illness: Asthma can grow harder to control with age

In early June, Donna Bilgore Robins stood on a patio in Beaver Creek under a crystal-clear blue sky and tried to catch her breath.

She couldn’t.

With mountain vistas around her, Robins felt as if she were drowning. She gasped for air hungrily again and again. Robins, 63, knew all too well what was happening. Something — some kind of plant, something in the mountain air? — had triggered her asthma.

She also knew she was in danger, even with a rescue inhaler at hand. “I don’t slowly get sick — I just drop,” said Robins, who, with help from her husband, was soon on the road to seek medical attention more than 100 miles away at National Jewish Health in Denver, a leading hospital for people with respiratory conditions.

For people such as Robins, diagnosed with asthma as a child, aging with this condition can be fraught with difficulty.

Older adults with asthma are five times as likely to die from the condition as younger asthma patients, according to a new review of asthma in seniors. And medical complications are more common.

As the prevalence of asthma in seniors climbs, more people will grapple with its long-term impact. Estimates vary, but up to 9 percent of older adults are thought to have asthma, which inflames the lungs and interferes with breathing.

With the advance of years, physical changes take a toll. People’s lungs become less elastic, their chest walls more rigid, and the muscles that help power the respiratory system less strong, exacerbating breathing problems, explained Michael Wechsler, co-director of the Cohen Family Asthma Institute at National Jewish Health and a co-author of the new review.

Compromised vision, fine-motor coordination and cognition can make it difficult for seniors to use inhalers correctly. Fewer than half of older adults with asthma do so, some research suggests, and many people on fixed incomes can’t afford these medications, which can cost up to $300 a month.

With age, the immune system’s response to inflammation becomes blunted, making it harder to fight off infections that can trigger asthma exacerbations.

Other biological changes, notably shifts in patterns of inflammation, may reduce older patients’ response to inhaled corticosteroids that need to be taken daily.

“Either patients have more inflammation and they need higher doses, or they have a different kind of inflammation and steroids may not work as well,” Wechsler said.

In addition, other medical conditions — such as chronic obstructive pulmonary disease, congestive heart failure and heart disease — can coexist with asthma and complicate diagnosis and treatment.

Research shows that seniors tend to prioritize other medical conditions over asthma, perhaps because they minimize symptoms and underestimate their impact, suggested Michael Wolf, a professor of medicine at Northwestern University’s Feinberg School of Medicine.

“Older adults have a tendency to ignore difficulties with breathing,” noted Rachel Taliercio, a pulmonologist at the Cleveland Clinic. “Instead of thinking this could be asthma, they think, ‘I’m overweight, I’m out of shape, I’m getting older, and this is normal at this time of life.’ “

Physicians can also be slow to recognize asthma. “In the elderly, sometimes the only manifestation of asthma is shortness of breath and a cough,” said Kaiser Lim, a pulmonologist and critical-care specialist at the Mayo Clinic in Rochester, Minn. “But some primary-care doctors kind of shrug off these symptoms.”

Up to half of older people with asthma haven’t been accurately diagnosed, according a review article in the Lancet.

That includes people with adult-onset asthma who first developed this condition in middle age or later.