Emergency Bronchodilators Less Beneficial for Elderly
Researchers from Harvard University in Boston, Jewish General Hospital in Montreal, Summa Health System in Akron, and MetroHealth Medical Center in Cleveland have found that older patients may be less likely to benefit from bronchodilators in emergency departments (EDs).
In a study of 2,064 patients with asthma, all age groups had severe exacerbations. Patients 55 years of age and older, however, were least likely to report severe symptoms upon their arrival at the ED. Nonetheless, they received more inhaled beta agonists during their stay in the ED, were more likely to receive systemic corticosteroids and other asthma treatments, and had longer ED stays. Despite the more intense therapy, they showed the smallest change in peak expiratory flow.
Over the previous year, older patients made fewer urgent clinic and ED visits but were admitted to the hospital more often for asthma than younger patients. Patients in all age groups were equally likely to report using the ED as their usual site of care for problematic asthma, but older patients were the least likely to receive their prescriptions in the ED.
The researchers suggest that older patients tend to use other drugs that can interact with bronchodilator therapy; they have more comorbid conditions; aging affects the time course of drug absorption, distribution, and metabolism; and airway remodeling may lead to a poorer response.
Especially critical is the fact that more than half of the older patients were not taking inhaled corticosteroids, although 91% had a primary care provider. Research has shown that inhaled anti-inflammatory drugs and rescue corticosteroids are underused in older patients. Physicians may hesitate to prescribe inhaled cortico-steroids because of concerns about adverse events, even though—as this study suggests—not using them can lead to poor asthma control and a more frequent need for hospital care. buy esomeprazole
