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When Asthma Strikes Later in Life

Forty percent of asthma victims don't have their first attack until after age 40. If you're not breathing easy, take action now.

If you find yourself battling a persistent cough or wheezing, you may be surprised to find that you're among a growing number of adults with asthma.
Asthma, a chronic disease of the airways, is often thought to be a childhood condition, but it’s not at all uncommon to be diagnosed in midlife. The Center for Managing Chronic Disease reports that 40 percent of sufferers had their first asthma attack after age 40, and the number of adults 65 or older with asthma in the U.S. is expected to double from the current 3.1 million to 6.2 million by 2037.

Why Asthma Can Go Undiagnosed

A study published in the May issue of The Annals of Allergy, Asthma and Immunology found that asthma is often misdiagnosed or undertreated in older Americans, among whom only 53 percent with the condition use prescribed inhalers.

There are a variety of reasons asthma can go undiagnosed until middle age or later, says Dr. James Sublett, chair of the American College of Allergy, Asthma and Immunology (ACAAI) public relations committee and founder of Family Allergy and Asthma in Louisville, Ky. “Some of these older adults may have had asthma since childhood and may have been misdiagnosed with chronic colds or repeated bronchitis," he says.

Also, some women may not have realized that they had asthma, Sublett says, because the hormone progesterone "seems to have a calming effect on the airways" — but when that hormone naturally decreases during midlife, "asthma symptoms can become worse.”

Even people with asthma symptoms, such as shortness of breath, simply do not realize they may have the condition, instead blaming their discomfort on normal aging or simply being out of shape. Doctors can fail to detect asthma in adults as well. “It can be difficult to distinguish asthma from Chronic Obstructive Pulmonary Disease [COPD], since COPD is often seen in older adults, especially if they have smoked,” says Dr. Norman Edelman, chief medical officer for the American Lung Association and professor of internal medicine at New York's Stony Brook University Medical Center. “Some of the symptoms of asthma in adults, such as coughing and shortness of breath, can also mimic symptoms of gastroesophageal reflux disease [GERD] and heart disease.”

(MORE: Live a Comfortable Life Despite an Ongoing Health Problem)

Allergies that begin to affect people in midlife and beyond can be major causes of new asthma cases. The May study found that 89 percent of older adults with asthma also had an allergy to mold, animals, dust or dust mites. Air pollution caused by auto traffic can also be a significant asthma trigger, especially in older sufferers, according to a study published in the June issue of The Annals. "The health effect of outdoor air pollutants on asthma in baby boomers," co-author Dr. David Bernstein, of the American College of Allergy, Asthma and Immunology, said in a statement, “is substantial and underappreciated.”

Whatever the reason for the late diagnosis, allowing your asthma to go untreated can lead to decreased lung function and poor quality of life, and potentially take a toll on other vital organs, including the heart. "If you have troubling symptoms — such as shortness of breath, wheezing, waking up at night coughing, or if you suffer from several bouts of bronchitis each year — and your symptoms aren’t being properly controlled," Edelman says, "ask your primary care doctor for a referral to a pulmonary physician."

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To determine the whether you have asthma, a doctor will likely need to perform a pulmonary function test, which measures how well your lungs take in and release air and circulate oxygen through the body.

Living With Asthma

If you are diagnosed with asthma in midlife or beyond, you'll have to start taking steps to effectively control your symptoms:
Know Your Triggers. “It’s important to identify the irritants that bring on your asthma symptoms,” such as cigarette smoke or dust, Sublett says. “I think all adult asthmatics should be screened for allergies, since 30 percent of adult asthma cases are triggered by allergies.” You can learn more about avoiding or eliminating triggers, including those caused by mold and cleaning products, from the American Lung Association.
Manage Your Condition. “Having asthma doesn’t mean just utilizing a rescue medicine when you experience symptoms,” Sublett says. “You also need to be proactive about preventing symptoms by using long-term control medicines that help to decrease swelling in the lungs and mucus production.”
Have an Action Plan. “Asthma isn’t a stable disease,” Edelman says. “It’s important to have a plan so that you know what to do when you have problems breathing.” The American Lung Association recommends that people with asthma work with their physician to create a written, individualized plan, on paper, that gives you and your loved ones specific instructions for early treatment of symptoms. The plan should include specific steps to keep an asthma attack from getting worse, and guidance on when to call your doctor or go to the emergency room. It will also include a list of your triggers, information about the medications you take, and your peak flow rate, which is a measure of your ability to push air out of your lungs. This can be determined with a peak flow meter to help you gauge the severity of a given attack. Find sample action plans here.
Take Control. “Losing weight, if you’re overweight, and quitting smoking are two of the best things you can do" to limit your asthma symptoms, Edelman says. Asthma patients age 65 and older who are obese are five times more likely to have poorly controlled asthma than asthmatics of normal weight. Studies in the American Journal of Respiratory and Critical Care Medicine have shown that asthmatic smokers who quit the habit can reverse lung damage that exacerbates their breathing difficulties, regardless of how long or how much they smoked in the past.

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