Under-diagnosis of asthma a problem with older people

Asthma is not just a childhood disease; it can occur at any age. The classic symptoms of asthma — coughing, wheezing, breathlessness and tightness of chest — can easily be misinterpreted as part of normal ageing or be misdiagnosed as other health problems in older adults. Older people may not report their symptoms; may attribute their symptoms to another illness or disease or normal ageing; or may simply ignore their symptoms. Here are some of the most common reasons for unrecognised asthma in older people.

  • Heart or lung diseases with similar symptoms to asthma, such as wheezing, can mask the presence of asthma.
  • The actual symptoms of asthma might be dismissed as other conditions. For example, a chronic cough might be mistaken for bronchitis, or the inability to sleep during the night may be dismissed as insomnia.

Conditions which have symptoms in common with asthma in the elderly include:

  • chronic obstructive pulmonary disease (COPD);
  • chronic bronchitis, emphysema, or acute respiratory illness;
  • rhinosinusitis with postnasal drip;
  • tuberculosis;
  • gastro-oesophageal reflux; and
  • cardiac diseases such as congestive heart failure, acute myocardial infarction (heart attack) or cardiac arrhythmia (abnormal heart rhythm).

Different triggers in older adults

Triggers for asthma attacks can differ in older adults with asthma from those most commonly affecting children with asthma. In older adults, viral respiratory illnesses (for example, colds and ‘flu), and airborne allergens are the most common triggers. This is why it’s important that older adults have an influenza vaccination every year. Pneumococcal vaccine is also recommended for all people who are over 65.

Some medications used frequently in older adults are also known to trigger asthma or make symptoms worse. Examples include: aspirin and other anti-inflammatory medications used to treat arthritis and other pain; beta-blockers used to treat hypertension (high blood pressure) and heart disease; and beta-blocking eye drops used to treat glaucoma. For this reason, it is important to keep a list of all the medications you currently use and show it to your doctor at each visit.

Complications of asthma in the elderly

In addition to the issues above, changes in lung structure and function brought about by normal ageing may make the problems associated with asthma worse in the elderly.

Also, normal, age-related changes in the body mean that older people with asthma are more susceptible to adverse effects from the very medications they are taking to control their asthma. They may also be at risk of adverse interactions between different medications they are taking.

Remembering to take medications for chronic conditions, such as asthma, may be more of a challenge for older people than younger ones. Also, problems with co-ordination or arthritis of the hands may make using puffers and other asthma medication delivery devices difficult, and problems with eyesight may affect ability to read labels. If you have problems coordinating drug release and inhalation, you may find it easier using the puffer in conjunction with a spacer. Alternatively, you may be better off using a breath-activated device such as an Accuhaler, Autohaler or Turbuhaler.

Questions for older adults who suspect they may have asthma

  • Have you experienced an attack or recurrent attacks of wheezing?
  • Have you had a troublesome cough or wheeze on waking up in the morning?
  • Do you have a tendency to cough or wheeze after exercising?
  • Do you experience a cough, wheeze or chest tightness after exposure to airborne allergens or pollutants?
  • Do colds go to your chest or take more than 10 days to clear up?

What to do

If asthma is suspected, see your doctor who will make a diagnosis and prescribe the appropriate treatment. Making the diagnosis will probably involve doing some basic lung function tests, performed before and after using an asthma reliever medicine. Many doctors have such testing equipment in their surgeries and it can be done by them or their practice nurses. They may also order a chest X-ray to rule out other disorders or to diagnose co-existing conditions.

You should also follow the same recommended general rules for the control of asthma that all people with asthma are encouraged to follow — these will be incorporated in the written asthma action plan that you develop with your doctor.

Last Reviewed: 18/11/2009



1. National Asthma Council Australia [website]. Asthma management handbook 2006. Asthma in the elderly (updated 2007, May 31). Available at: http://www.nationalasthma.org.au/cms/content/view/41/49/ (accessed 2009, Nov 23)