Many people get their first attack of asthma when they are very young and it goes away gradually as they grow up, but it may come back later in life when they become old. Sometimes people get an asthma attack for the first time when they are old.

So, there is no guarantee that if you have been asthma for the first half of your life, the disease will not attack you in the later stages.

What are the common triggers of asthma in elderly people:

* Triggers of asthma attacks in older people can be quite different from those most commonly affecting people with asthma.

* In older adults, viral respiratory diseases such as cold, flu; and airborne allergens such as pollen, dust, smoke are the most common triggers of asthma. This is why it's necessary that older people have an influenza vaccination every year along with a pneumococcal vaccine every 5 years for people who are over 65.

* Depression and/or anxiety are also a common trigger of asthma.

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

Why is it difficult to diagnose as well as treat asthma in older people?

* In older people, it is sometimes difficult for the doctor to ascertain whether the problem is actually asthma or some other lung disease or heart disease. Other lung problems that can cause similar problems are bronchitis, particularly common in people who smoke. Bronchitis and emphysema many a times seem like asthma, infact asthma may also seem like bronchitis and emphysema. Heart disease may also cause breathing problems.

* Older people are more likely to have other health related problems. They may have diabetes, high blood pressure or heart problems and need to take regular medication for these problems. Sometimes a drug that is advised for one disease may not respond well while interacting with other drugs and may also lead to some side-effects.

* Older people may not be regular in taking their medications, which may lead to sudden flare up of controlled asthma. They may forget certain doses, or may not be able to diagnose the symptoms of an attack. Treatment of asthma means recognizing asthma triggers early, knowing as well as understanding early warning signs, which older people may find difficult.

* People at an old age find it difficult to give up certain habits such as smoking or certain relished foods which may be asthma triggers.

* Old patients for several reasons are often treated with a less aggressive therapy than what's actually needed. So, the results take time to show up.

Under-diagnosis of asthma ? an universal problem with old people:

The normal symptoms of asthma - coughing, wheezing, shortness of breath and tightness of chest ? is at times misinterpreted as part of old age problems, or may be misdiagnosed as other health problems in older adults. Older people are usually not alert in recognizing their symptoms; may attribute their symptoms to normal ageing and simply ignore the symptoms altogether.

Some of the most common reasons for under-diagnosis of asthma in older people are:

* Heart or other respiratory diseases such as bronchitis, which have symptoms similar to asthma.

* Old people are not able to express their symptoms correctly, which may lead to false diagnosis.

* The actual symptoms of asthma might be mistaken for other conditions, for example, a chronic cough might be mistaken for bronchitis.

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

* chronic obstructive pulmonary disease (COPD);

* chronic bronchitis, emphysema and other respiratory illness;

* rhino-sinusitis

* tuberculosis;

* gastro-oesophageal reflux

* cardiac diseases such as congestive heart failure, heart attack or cardiac arrhythmia.

Some differences between asthma and COPD are that nearly all people with COPD are smokers or ex-smokers who have started to get symptoms in mid-life. Asthma is more likely to present earlier in life. Moreover, people with COPD tend to be breathless all the time whereas those with asthma will be breathless sometimes.

Complications of asthma in the elderly people:

* Alteration in lung structure and function brought about by the normal ageing process may make problems associated with asthma worse and difficult to treat in the elderly.

* Because of age-related changes in the body, older people are more susceptible to adverse effects from medications they are taking to control their asthma.

* Older people often forget to take their medications regularly, and thus the condition often gets out of control. Also, problems with co-ordination may make use of inhalers and other asthma medication delivery devices difficult.

If you don't understand what the doctor has prescribed, do not hesitate to ask questions repeatedly. To help yourself, be clear about -

* What medications to take and when

* What the signs of an asthma attack

* When to call the doctor

Asthma management in elderly is a tough job which requires lot of patience. While caring for the elderly patients with asthma, one must follow the general principles of geriatric care.