Controlling Triggers for Asthma in Older Adults: Environmental Allergens, Indoor and Outdoor Air Pollutants, and Infection

Asthma exacerbations and poor asthma control in older adults are often related to a variety of environmental exposures including: indoor allergens, respiratory infections and indoor/outdoor air pollution. It is important for physicians and patients to recognize and avoid potential triggers in order to reduce associated morbidity and mortality. An environmental history is therefore crucial in the evaluation of older adults with asthma in order to identify potential triggers and targets for remediation. Older individuals tend to spend more time indoors and live in older homes with older furniture that has accumulated allergens. This can lead to greater exposure to common indoor allergen triggers, including house dust mite, pets, cockroaches and mold. Older asthmatics may also be more greatly impacted by respiratory infections due to immune senescence, age related physiologic changes, and the potential for increased exposure to infectious agents in residential living facilities. Diligence to infection prevention strategies including use of age-appropriate vaccinations is critical to help prevent exacerbations. Older adults are also more susceptible to the effects of residential air pollution due to their increased time spent indoors, and age related decline in anti-oxidant defenses. Given that many types of exposures can play a role in poor asthma control in older adults, multi-faceted interventions are generally more effective than single interventions.