Sometimes people who have had asthma all their life may find that it starts affecting them differently as they get older, for example they may become more breathless. Others may not be diagnosed with the condition until later in life. This is what is known as late-onset asthma.

How do I know if it’s asthma?
If you have asthma, you will experience some or all of the following:

Coughing
Wheezing
Shortness of breath
Tight chest

With older people, shortness of breath sometimes may be the only symptom. However, it can be difficult to tell the difference between asthma and other conditions such as bronchitis, emphysema, heart disease and COPD (chronic obstructive pulmonary disease).

Some notable 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. People with COPD tend to be breathless all the time whereas those will asthma will only be breathless sometimes.

Your doctor will be able to confirm the diagnosis.

What triggers asthma symptoms in older people?
Asthma triggers vary from person to person, with most people finding that more than one trigger can bring on their asthma. In older people, the symptoms of asthma are less likely to be triggered by allergies such as house dust mites, furry and feathered pets and pollen. They are more likely to be triggered by flu, colds or other viral infections, exercise, laughing or excitement, depression or anxiety, some medications and irritants such as cigarette smoke, cold air, perfume and chemical fumes.

While evidence so far suggests that asthma is not caused by air pollution, studies have shown that it can trigger symptoms in people who already have the condition. Those most at risk include people with severe asthma and older people with heart or chronic respiratory problems.

What about the flu?
People with asthma are at a greater risk from flu than others. In Ireland, a flu vaccine is available from GPs for those deemed to be ‘at risk’, including people over the age of 65.

However, people with asthma may be unaware that even if they are not yet 65, they should also be receiving the flu vaccine, which is given annually usually in October or November. According to Department of Health guidelines, any person with ‘persistent asthma’ should be vaccinated against flu. Two in three people in Ireland with asthma have persistent asthma, which means they have to use both reliever and preventer medication. (People with intermittent asthma on the other hand, only need to use reliever medication.)

Consult your doctor about the vaccine. Older people with severe asthma should also talk to their doctor about whether the pneumococcal pneumonia vaccination might also be appropriate.

Are there any medications I should avoid?
There are a number of medications available on prescription and over the counter that can trigger asthma symptoms in some people. These include:
Beta-blocker tablets used to treat high blood pressure, heart problems and anxiety. There are alternative ways to treat all three conditions
Beta-blocker eye drops, which are prescribed for the treatment of glaucoma
Aspirin, which is used in many medicines for headaches, colds etc. Paracetamol can be used as an alternative. If you are using aspirin for a heart condition, consult your doctor for advice
Ibuprofen, which is available in tablet and cream form for rheumatic pain, belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDS). These can cause problems in a small proportion of people with asthma.

Should I stop exercising because I have asthma?
No. Exercising regularly can help your asthma. Walking is particularly good and you don’t have to walk very far or very quickly. Swimming is also a good exercise, as it puts very little stress on the weight-bearing joints, such as knees and ankles. Yoga is also good.

Your doctor may suggest that you take a puff or two of your reliever inhaler before you exercise, as this can stop the asthma symptoms from appearing.

What is a self-management plan?
A self-management plan is a written record that drawn jointly by you and your doctor/nurse.

It tells you which medicines have been prescribed for your asthma and how many times you need to take these each day. This can be helpful if somebody else is helping you with your asthma control.

The plan also keeps track of how well your asthma is being controlled and what to do when your asthma gets worse.

What to do in an asthma attack?
It is a good idea to discuss what to do in the case of an asthma attack with your doctor or nurse so that you are prepared.

Some general guidelines include:
Take your reliever inhaler straight away, as directed by your doctor, preferably using a spacer
Try to remain calm. Sit down but do not lie down. Try to slow your breathing down as this will make you less exhausted
Wait five to 10 minutes
If the symptoms disappear, you should be able to return to what you were doing.
If the reliever has no effect, call a doctor or ambulance
Keep taking your reliever every few minutes until the doctor/ambulance arrives
Take your steroid tablets if your doctor has written them into your self-management plan

The same applies if you suffer an attack during the night. Seek help immediately and don’t leave this until the morning.

Is my breathlessness just a sign that I am getting older?
Not necessarily. Some people mistakenly think that getting breathless is an inevitable part of growing older. Always check this out with your doctor because it is quite likely that your breathlessness is caused by a condition that can be treated.

Will moving to a different part of the country help my asthma?
There is no evidence that moving house will improve your asthma symptoms. Air pollution can be a trigger for some people, but it is only one of many things that can affect asthma.

Even in the least populated parts of Ireland, the proportion of people with asthma is about the same as that elsewhere.

Is it safe for me to have an operation?
It is safe for you to have an operation, although you need to discuss the fact that you have asthma with the hospital consultant. If you need an anaesthetic, you may be asked to take a series of peak flow measurements a few weeks before your operation.

For more information, contact the Asthma Society of Ireland on freephone, 1850 44 54 64.

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