WAY FORWARDPeople with asthma in old age should remember the following:• People who exercise stay healthier • Overweight people with asthma who lose weight have fewer asthma symptoms • Non-smokers do

not get as many asthma symptoms and their medicines are more effective.• Stress, anxiety and depression can make asthma worse. Avoid supressed anger, worry, loneliness and fear• Keep your doctor’s number at hand

According to Dr Bruce Kirenga, a pulmonologist at Mulago Hospital, asthma is a disease of the lungs that causes the airways to be blocked (constricted), hence making it diffi cult to breathe. Symptoms include breathlessness, coughing, wheezing and a feeling of tightness in the chest. These vary in frequency and severity. When the symptoms are not under control, the airways can become infl amed, making breathing diffi cult.

Asthma is sometimes thought of as a childhood disease, but it is often diagnosed as a new condition in older people. In fact, it is common in people over 65 years, where it causes serious health problems if not treated properly.

According to Asthma and Allergy Foundation of America, asthma can attack anyone at any age. Unfortunately, asthma creates a much greater risk for older people because they are more likely to develop respiratory failure as a result of the asthma, even during mild episodes of symptoms.

Unlike in younger persons, asthma in older people rarely goes into remission. Instead, it is more likely to remain a potentially serious and many times, disabling disease.

WHAT CAUSES ASTHMA?Kirenga says asthma is caused by interplay between the genes and the environment.

“The common environmental factors that trigger it off, what we call asthma-allergens, are pollen, house dust, mites, insects such as cockroaches, certain chemicals used in industry and many others,” he said. “There is also smoking,

smoke from cooking with biomass such as wood and charcoal and air pollution. But a person can also contract asthma from infections of the lung, such as Tuberculosis.”

Kirenga says people with asthma have swollen airways, excess airway mucus and the airway is irritable. They react more to exposures that would otherwise not cause a problem to people without asthma.

WHO IS LIKELY TO DEVELOP ASTHMA IN OLD AGE?The foundation has discovered that patients who had asthma during earlier life may suffer from it in elderly times. Patients who develop sinusitis in adulthood may also get a later development of asthma. Kirenga adds that you are likely to get asthma if you a have family history of asthma or have other allergies.

HOW TO MANAGE ASTHMA IN OLD AGEAmong seniors, the goals of asthma treatment are to prevent symptoms and attacks, maintain normal activity levels, including exercise, have normal or near-normal lung function and have no or the least side effects while getting the best medications.

Treating asthma among the elderly is complicated due to interactions among effects of aging, asthma and coexisting conditions. The lung structure has already been affected by the normal aging-related changes which are likely to exaggerate asthma symptoms.

However, Dr Martin Okot Nwang, a pulmonologist at Easy Breath Chest Clinic in Kamwokya, Kampala, says this does not call for special attention; the elderly can continue using the asthma

Handling asthma among the elderly

There are a few things that every one should know about asthma.

KNOWLEDGEPatients and their carers should learn more about asthma, the condition of the patient and the medicines the doctor prefers on the patient. During hospital visits, they should endeavour to ask the doctor everything that they would like to know. If possible, keep the doctor’s contact

for further reference.

AGEING CONDITIONSThe elderly already have decreased ability to handle multiple complex stimuli, memory problems, loss of co-ordination and muscle strength that may make it diffi cult to use metered-dose inhalers, hearing and visual diffi culties, sleep disturbances that may impair cognitive function, and depression.

WHAT TO EATOkot says carers should identify the food that triggers allergies among the elderly, cough or an attack and avoid it or get desensitised to that kind of food.

PROTECTIONAsthma patients should always have a warm jacket ready in case a problem of cold arises. “If such a person is travelling, is in offi ce or at home, the cold, air

conditioners, or the wind can trigger off an attack. If it is the air conditioner, request a transfer to another room, section or you resign and look for another job,” Okot says.

AMBIANCE AND MOODThere is a risk of attack when a person is sad, losses a job, a loved one or a business. The elderly need family and to feel loved so as to keep stress and worries away.

WHAT YOU SHOULD KNOW ABOUT ASTHMA AND RELATED COMPLICATIONS

According to Yasin Zziwa, a naturopath with Sez Medicinal Centre in Bwaise, a Kampala suburb, the causes of asthma attacks mainly include environmental pollutants bacterial or viral infections, too much fatty and sugary foods, stress, air conditioner, exposure to heavy perfumes and excessive consumption of animal products, such as milk and beef. Zziwa advises the victims to eat black pepper, drink ginger and cypress to unclog the veins.

“Steaming is also good because of the herbs used, such as eucalyptus and cypress among others,” he says.

drugs they have been using over the years.

“Sometimes, they may have a disease such as diabetes or hypertension whose drugs may sometimes interact with asthma drugs and interfere with drug effectiveness, making the disease worse,” he says.

Kirenge says asthma should be treated early, when one is

still young and can withstand symptoms because at an elderly age it becomes diffi cult to eradicate. However, the symptoms can be controlled, enabling people with asthma to live full lives.

TREATMENT Asthma symptoms can be treated with medications that provide quick relief, as

well as long term control. But lifestyle changes are also needed, especially if asthma is triggered by allergies to substances in the environment or to certain foods.

Doctors advise that while short-term use of asthma drugs is helpful to treat acute asthma symptoms or fl are ups; long-term use of the drug should be avoided in older asthma patients because it can cause severe side effects, such as weakening of bones, ulcers or high blood pressure.

Kirenge says some asthma drugs open the airways and others reduce the swelling and mucus

production.Okot adds

that if the elderly person is already taking other drugs, such as for diabetes, which interfere with the control of asthma, they have to be replaced.

World Asthma Day is always celebrated on the fi rst Tuesday of May. The initiative, which began in 1998, was spearheaded by the Global Initiative for Asthma, an organisation that sets medical guidelines for the control of the disease. The day focuses on educating the public on ways of controlling and treating asthma. Jacquiline Nakandi takes us through the management of asthma among the elderly

A health worker explaining to parents and children how to use an inhaler. Photo by Ramadhan

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HOSPITAL VISITSOkot says there are drugs for emergencies in severe attacks, but if the diffi culty in breathing seems not to be easing, the patient must be rushed to hospital.

Kirenge adds: “When wheezing is not ceasing, the breathing is abnormal, the patient loses ability to speak in full sentences and the emergency medicine is not working after two hours, rush to a hospital. And if they get better with emergency

medicine, but after four hours another attack returns, take them to the hospital.”

“Every asthma patient should carry an inhaler,” Okot advises. “The carer should also learn how to give emergency treatment in case a patient gets an attack.”

hours another attack returns, take them to the hospital.”

“Every asthma patient should carry

elderly person

drugs, such as for diabetes, which interfere with the control of asthma, they have to be

an inhaler,” Okot advises. “The carer should also learn how to give emergency treatment in case a patient gets an attack.”

drugs open the airways and others reduce

medicine, but after four hours another attack

the swelling and mucus

hours another attack returns, take them to the hospital.”

patient should carry an inhaler,” Okot advises. “The carer should also learn how to give emergency treatment in case a patient gets an attack.”

People with asthma should always have an inhaler nearby