Treatment of Asthma in Elderly
Medications used in treatment of asthma in elderly include sympathomimetics, corticosteroids, xanthine derivatives and anticholinergics but the dose of the drugs is to be altered to certain extent in elderly persons.
Most of elderly patients are previously on cardiac, diabetic medications or are taking treatment for other illness, so the drugs used in asthma should be such which compliment the previous treatment and do not cause any adverse effects.
1. Sympathomimetics
- In elderly, salbutamol or terbutaline are usually preferred by inhalation route in form of inhalers or Rota halers.
- High oral doses in elderly may lead to fine skeletal muscles tremor (especially hands), tachycardia, palpitations, nausea and headache.
- Especially in a cardiac patient these adverse reactions may lead to cardiac arrhythmias.
- In acute attack- intravenous administration may lead to arrhythmias, metabolic effects and in high doses along diuretics and xanthines may lead to hypokalaemia.
2. Theophylline
- It is a xanthine derivative and a direct bronchial muscle reaction. It acts synergistically with beta-2-agonists.
- Theophylline should be given as a starting dose of 3-4mg/kg/body weight.
- Theophylline is metabolized in the liver, so the dose has to be reduced in elderly as well as in adults with liver disorders.
- Hepatic metabolism of theophylline is enhanced by drugs like phenytoin, phenobarbitone, and rifampicin and by smoking.
- Elderly patients, who are chronic smokers, usually require increased doses.
- It may cause cardiac arrhythmias in pre-existing cardiac disease.
3. Corticosteroids
- They are usually used in inhalation form so as to reduce systemic side effects.
- In intravenous form corticosteroids are to be used cautiously in elderly diabetics and in persons suffering from adrenal insufficiency, fungal infection and in chronic renal failure.
- Long term use of inhaled steroids can lead to candidial infection of oral mucosa so these individual have to be advised to rinse the mouth with water after each dosing.
- Corticosteroids along with beta-2-adrenergics and xanthine derivatives increase chances of hypokalaemia in these people.
- Increased doses of corticosteroids also increase incidences of peptic ulcers especially in elderly who are on concurrent treatment with non-steroidal anti-inflammatory drugs.
- Corticosteroids are to be tapered gradually or may result in repeated exacerbation of asthmatic attacks.
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