Under-diagnosis of asthma in elderly

Abstract

Introduction: The concept of asthma affecting the old age people has been universally denied in past. Therefore, rather than suspecting asthma in old age patients, it often gets misdiagnosed as chronic obstructive pulmonary disease (COPD), leading to sub-optimal management of disease. Considering the fact that only one in five life-long smokers ever develop COPD, we must not blindly diagnose it in elderly smokers without going through clinical evaluation. Spirometry can be helpful in differentiating asthma; however, demonstration of small degree of reversibility to bronchodilators alone does not distinguish asthma. Comorbidities in old age or the drugs taken to treat them may exacerbate asthma. Conversely, bronchodilators and corticosteroids used to treat asthma often worsen these co-morbid conditions, such as osteoporosis, diabetes mellitus, and cardiac arrhythmias - making our regimens even narrower. Objectives: To highlight the misdiagnosis of asthma in old age. Materials and Methods: A prospective study was done involving 350 clinically diagnosed obstructive airway diseases (OADs) patients at SBKS Medical Institute and Research Center and their evaluation was done. Results: Out of 350 patients clinically appearing as OAD, 292 had obstructive pattern in pulmonary function tests; from which 100 were found to be asthmatic and 192 were of COPD. Out of these 100 diagnosed asthma patients, 16 were of age more than 60 years, from which five were previously treated as COPD. Conclusion: There is considerable prevalence of asthma in old age too, which, if misdiagnosed, can lead to sub-optimal treatment of the asthma