It’s as plain as the runny nose on your face and the clump of tissues clutched in your hand – or is it? You’re 50 years old and for some reason, you’ve entered the world of sniffles, coughs, rashes and wheezes.
More than likely you are dealing with allergies or asthma. And while you may not have had problems ever before, your immune system at 50 is not what it used to be.
“Age is not the only factor, but it can contribute to an increase in allergies and allergy-induced asthma,” says Dr. Mark S. Dykewicz, associate professor of Internal Medicine and training program director, Division of Allergy and Immunology, St. Louis University School of Medicine. “The simple truth is as we get older our immune system begins to break down.”
Dr. Dykewicz says asthma and immune response are tightly intertwined. Immune responses in the form of allergic reactions trigger attacks in about half of the adults with asthma. And to a large extent, immunologic events determine the degree of inflammation that will accompany allergic reactions and thus the severity and duration of asthma attacks.
“Although sometimes mistakenly viewed as a trivial disease, symptoms of allergic and non-allergic rhinitis (hay fever) may significantly impact a patient’s quality of life by causing fatigue, headache, cognitive impairment and other systemic symptoms,” Dr. Dykewicz explained.
Some people over 50 had asthma when they were children or young adults, and now the problem has come back. In two studies by the American Lung Association, more than a quarter of the people over 65 had some form of wheezing, a common symptom of asthma. There may be wheezing with or without colds, or there may be attacks of shortness of breath with wheezing. And you can have asthma even if you don’t wheeze.
It is often difficult for a doctor to decide whether the problem in a patient over 50 is asthma or another lung disease. Other lung diseases that cause similar problems are bronchitis and emphysema, especially in people who smoke. Older people who are allergic to pollen, pets or dust are at higher risk of developing asthma too. Heart disease may also cause breathing problems, and a person can have heart and lung disease at the same time.
Asthma diagnosis in the young is facilitated by a relative scarcity of other conditions that mimic asthma or complicate its clinical presentation. In the elderly, however, the differential diagnosis of episodic chest symptoms expands as cardiovascular disease and other forms of chronic lung disease become more prevalent.
So what is asthma? Simply put, asthma is a physical problem that makes it more difficult to breathe. When you inhale, air comes in through your nose, and it passes down the bronchial tubes to your lungs. When you exhale, stale air from your lungs exits through the same tubes. But when you have asthma, the breathing tubes are sensitive. They react to smoke, pollen, dust, air pollution allergies and/or other triggers. The breathing tubes respond by becoming tight, inflamed and swollen, and that makes it harder to breathe.
The allergic response is a defensive reaction of the immune system against allergens, which are innocuous substances that the body interprets incorrectly. The body mistakenly identifies substances such as pollens, animal dander, foods, insects and their venom, and some medications, as dangerous.
Symptoms vary widely because different allergens stimulate the immune system at different sites in the body. The respiratory system is the most common site of allergic reactions. Allergens in the upper airways cause sneezing and nasal congestion, while lower airway distress includes bronchoconstriction and wheezing.