Asthma is a chronic pulmonary disorder that is characterized by an inflammation and hyper-responsiveness of the airways and causes several symptoms, including coughing, shortage of breath, tightness in the chest area, and wheezing. Although asthma is generally diagnosed early in life, all age groups can suffer from asthma and be at risk for acute asthma exacerbation. Asthma is a serious issue because acute exacerbations can lead to high morbidity and mortality rates.
In 2009, more than 3,000 people died because of asthma (American Lung Association, 2012). Only 37 asthma-related deaths per year occur in children, but the risk for dying increases with age, so 204 deaths per year occur in younger adults while 903 older adults die every year because of asthma (Tsai, Lee, Hanania, & Camargo, 2012).
Chronic asthma has a complex pathophysiology that involves airway inflammation, intermittent obstruction in the airflows, and hyper-responsiveness. In most cases, mucus excretion and edema in the airways contribute to those conditions. Patients also display thickened lamina reticularis, increased eosinophils, and increased tissue contractibility.
Acute asthma exacerbations are characterized by severe airflow obstructions, but they also cause severe hypoxaemia and hypercapnia. Hypoxaemia is a deficiency of oxygen in the arterial blood while hypercapnia signifies that there is too much oxygen present in the blood. According to Barbera et al. (1997), the high ventilation/perfusion inequality and the lack of oxygen in blood are responsible for the inhibition of gas exchange during exacerbations.
While chronic asthma management mainly follows the same principles across all age groups, the treatment of acute asthma exacerbation would greatly depend on the age of the patients. The diagnosis is also usually similar in all cases. Exhaled nitric oxide proved to be an accurate, non-invasive method for asthma diagnosis, but it is complex and rarely used to diagnose asthma (Lemanske Jr & Busse, 2010).
Spirometry is frequently used for chronic asthma diagnosis because it is simple and effective. Although it was assumed that it was a difficult diagnostic method for older method, research showed that a well-trained staff can effectively use spirometry to diagnose asthma in 90 percent of cases among older patients (Gibson, McDonald, & Marks, 2010).
As a general rule, I would use long-acting bronchodilatators to alleviate airway obstruction and corticosteroids to relieve airway inflammation when prescribing asthma treatment. However, in older patients, I would aim for patient education, prevention, and risk management because long-term use of corticosteroids may promote the onset of other disorders, such as diabetes, obesity, or immunosuppressant, at their age. In addition, asthma symptoms can overlap with various other common disorders among the elderly, so a multidimensional assessment and intervention would be required (Gibson et al., 2010).
Some interventions that are non-invasive and helpful can be used on all age groups. For example, non-invasive ventilation can improve gas exchange in acute asthma exacerbations and minimize the need to use endotracheal intubation (Barbera et al., 1997). Furthermore, interventions aimed at relaxing the respiratory muscles are critical because they reduce the demand for oxygen and relieve hypoxaemia (Barbera et al., 1997).
Finally, it is evident that both children and adults can suffer from respiratory viral infections. Viral infections trigger acute asthma exacerbations in approximately 80 percent of cases (Busse, Lemanske Jr, & Gern, 2010). It is important to take viral influences in consideration before making decisions on interventions that can be used to alleviate the symptoms.
Figure 1. Acute asthma exacerbation mind map.
Figure 2. Chronic asthma mind map.
References
American Lung Association. (2012, September). Trends in asthma morbidity and mortality. Retrieved from http://www.lung.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf
Barbera, J. A., Roca, J., Ferrer, A., Felez, M. A., Diaz, O., Roger, N., & Rodriguez-Roisin, R. (1997). Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. European Respiratory Journal, 10(6), 1285-1291.
Busse, W. W., Lemanske Jr, R. F., & Gern, J. E. (2010). The role of viral respiratory infections in asthma and asthma exacerbations. Lancet, 376(9743), 826-834.
Gibson, P. G., McDonald, V. M., & Marks, G. B. (2010). Asthma in older adults. Lancet, 376(9743), 803-813.
Lemanske Jr, R. F., & Busse, W. W. (2010). Asthma: clinical expression and molecular mechanisms. Journal of Allergy and Clinical Immunology, 125(2), S95-S102.
Tsai, C. L., Lee, W. Y., Hanania, N. A., & Camargo, C. A. (2012). Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008. Journal of Allergy and Clinical Immunology, 129(5), 1252-1258.
