Table 1.

Important non-medication considerations for older 357 adults with asthma

Item	Possible solution
Symptoms of asthma are often similar to other age groups, but differences do exist	Ask about non-traditional asthma symptoms, such as fatigue
Older adults may have a decreased perception of dyspnea	Consider use of a peak flow meter to assist in assessment of airflow obstruction
Bronchial hyper-responsiveness to methacholine increases with age	Interpret results with caution, and consider a higher threshold for an abnormal test
Older adults with decreased cognition have poor inhaler technique	Consider breath-activated devices, spacers, and nebulizers
Comorbidities are common among older adults, and can negatively impact asthma	Identify, acknowledge, and address comorbidities where appropriate
Depression is especially problematic asthma management for older adults	Consider screening, treatment and/or referral for depression
Menopause is often associated with asthma exacerbations	The risks and benefits of hormone replacement therapy should be carefully considered in difficult to control asthma
Older adults frequently have caregiver roles for their spouse, children, or grandchildren	Acknowledge the challenges, and stress that to be optimally effective you must take care of your own health
Transportation can be problematic	Work with senior service agencies and social workers; schedule multiple appointments on the same day
Frequent use of complementary and alternative medicine (CAM) for asthma	Discuss risks and benefits of such therapies with your patient; consider how breathing exercises and asthma education can be incorporated
Poverty is a growing problem among older adults, and can adversely affect health	Use empathetic communication to discuss financial issues; prescribe medications with the lowest copay; refer to appropriate financial services