pollen dandelion weed webHaving Difficulty Breathing? You Could Have
Asthma — Often Undiagnosed in Older Adults

A disease that typically first develops in children and teens, asthma can develop at any age but is often more difficult to diagnose in older adults, says St. Luke’s pulmonologist Neal M. Fitzpatrick, MD, of St. Luke’s Pulmonary & Critical Care Associates.


In younger people, asthma is usually related to allergies, but older adults can develop asthma independent of allergies, says Dr. Fitzpatrick. As a result, it is often misdiagnosed and left untreated. In fact, the Centers for Disease Control and Prevention (CDC) reports that nearly 7 percent of people age 65 and older have asthma. In older adults, asthma usually involves risk factors such as excess weight or a history of smoking.
Wheezing — a high-pitched, coarse, whistling sound — is a common sign of asthma. If an individual experiences wheezing, they should see their primary care physician, who can diagnose and treat mild to moderate asthma, Dr. Fitzpatrick advises.
“Asthma is a condition that can be fatal even in cases that seem mild, so it needs to be managed by a physician,” Dr. Fitzpatrick said. “Having a rescue inhaler — something that can counteract inflammation in the lungs and open up those airways in emergencies — is essential for most cases of asthma.”
For patients with more complex cases of asthma, their primary care physician may refer them to a pulmonologist who works closely with both primary care physicians and allergists. St. Luke’s Pulmonary & Critical Care Associates physicians have treated patients throughout the Lehigh Valley for many years.
“We’re a phenomenal team of doctors,” Dr. Fitzpatrick says. “We treat our patients like family. If you come to a St. Luke’s pulmonologist, you’re going to get great care. Our doctors have diverse clinical experiences, and we work together to develop the best plan of care for each patient, including advance procedures.”
For example, Deborah Stalnaker, DO, performs bronchial thermoplasty. An innovative, non-drug procedure for patients 18 and older, bronchial thermoplasty uses heat to shrink the smooth muscle in the lungs that tighten during asthma attacks, making it hard to breathe.
Even for older adults, the most common trigger for asthma is allergies, spring being the peak period of allergy-related asthma complications. Many people also have difficulty in late summer and fall, when grasses pollinate.
Allergies and asthma are particularly prevalent in our area due to the abundance of pollen, a fine powdery substance produced by trees, flowers, grasses, and weeds to fertilize plants of the same species. In fact, the Asthma and Allergy Foundation of America recently ranked the Allentown Metropolitan Area as the worst of 100 American cities for people with inflammatory lung diseases.
“Eastern Pennsylvania is the pollen capital of the United States,” Dr. Fitzpatrick says. Because we live in a temperate environment with four seasons, we tend to have spurts of pollen. The Lehigh Valley is nestled between Blue Mountain to the north and South Mountain to the south. The resulting wind shields on multiple sides tend to keep the pollen hanging in the air.
Seasonal allergies occur when the body identifies pollen breathed in through the nose as something foreign. An allergic response is triggered, causing the nasal airways to swell. This, as well the body’s release of chemical agents, can bring about other symptoms, like sinus headaches, runny noses, and itchy, watery eyes.
“Allergies can cause symptoms up to, and including, a flu-like reaction, depending on the quantity of pollen that you have inhaled,” he says. “Your immune system is trying to alert the rest of your body that something foreign is trying to get in. Some people get body aches and fever, which is how we came up with the term 'hay fever.' You feel tired because the immune system is using a lot of energy.”
Asthma occurs when the pollen gets down into the lungs and the allergic reaction causes the bronchial airways to spasm and swell, making it hard to breathe. If left untreated, it can be serious and even life-threatening.  Asthma and allergies can also be caused by substances that are present year-round, such as pet dander, smoke, and dust mites.
To manage both allergies and asthma, the easiest thing is avoidance. If you have significant allergies, your doctor may send you for what they call an "allergy panel," where they perform tests to determine what you are allergic to, he said. For mild to moderate seasonal allergies, over-the-counter medications may be enough to manage the response for most people.

Over-the-counter allergy treatments include: 

antihistamines to decrease the symptoms by getting rid of histamines that cause nasal swelling, congestion, and tiredness.
decongestants, such as Sudafed and other medications that include pseudoephedrine to relieve congestion by causing blood vessels to constrict.
sinus rinses and neti pots, that use saltwater solutions passed through the nasal passages to remove the allergens that can get stuck.
nasal steroids, such as Flonase, to block the allergic reactions.

Dr. Fitzpatrick sees patients in Bethlehem, Easton, and Coaldale. To schedule an appointment with Dr. Fitzpatrick, call 484-526-3890. For more information, visit sluhn.org/pulmonary-care.

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