Nebulisers for the elderly
Authors: J. C. Pounsford
Journal: Thorax (1997)

Nebulisers for the elderly J C Pounsford Asthma mortality in England and Wales is the Hodgkinson's mini mental test, 5 was the best predictor of inability to use a metered dose slowly rising with about 2000 deaths per annum. 1 If these figures are examined with inhaler.In a further study a breath activated and metered dose inhaler was shown to be the respect to age, corrected for population size, mortality in patients over the age of 65 is rising only inhaler that some patients with moderately severe memory loss could use. 6 As 20% of significantly and deaths in those aged over 80 is increasing exponentially. 1 Some "asthma patients over the age of 80 are significantly cognitively impaired, assessment of cognitive deaths" may be explained by changing patterns in death certification with chronic obstructive function becomes an important aspect in the management of patients in whom inhaled ther-pulmonary disease (COPD) being certified as asthma.There is a need to ensure that older apy is being considered.For patients who are cognitively impaired a nebulised broncho-patients are diagnosed accurately and treated in the most appropriate manner.dilator would seem a useful option, but a well trained carer might be able to administer Nebulisers in the elderly are largely used to administer inhaled bronchodilators to patients bronchodilators satisfactorily with a metered dose inhaler and a spacer or a dry powder with bronchial asthma and COPD with reversibility.There is a lack of published data on inhaler.The relative paucity of evidence to show the efficacy and use of nebulisers in this age group, and clinical decisions tend to be based that nebulisers are better than metered dose inhalers, particularly when used in high dose on results from studies in younger patients.Some studies in COPD have included patients with spacers, necessitates all types of metered dose inhalers and dry powder inhalers being up to the age of 75 but the results have rarely been examined with respect to age.available and considered for each patient.The only inhaler device which has been shown to This paper will consider some of the special features of asthma in the elderly which might give a significant benefit to the elderly and patients with poor inhaler technique is the modify nebuliser use.In addition, some of the risks of high dose agonists and anticholinergic Autohaler. 7 8Many patients inhale well from the Autohaler but they have considerable drugs will be discussed.difficulty in spring loading the device.In a number of uncontrolled studies the Turbohaler is popular with patients although elderly Use of metered dose inhalers patients frequently complain that they are un-One of the most challenging problems in manaware whether they are receiving the drug when aging elderly patients with asthma is the dethey inhale from the device.The risk of inhalalivery of treatment to the lungs.Armitage and tion from an empty Turbohaler is not in-Williams 2 showed that age was a major factor considerable.when assessing whether patients were able to Having exhausted trials of various inhaler use a metered dose inhaler correctly, with devices including instructing patients and, if patients under the age of 65 doing significantly necessary, carers on the use of large spacer better than older patients.The older patients devices, a nebuliser needs to be considered if were significantly less likely to learn an inhaler patients are not adequately treated.Special technique than the younger patients.The study consideration must be given to the drugs and also showed that many metered dose inhalers the dosage that are conventionally used in currently available in the UK require connebulisers.siderable strength in the index finger and thumb to activate aerosol release.The force required could not be achieved by a large proportion of elderly patients studied.Buckley 3 assessed agonists The incidence of ischaemic heart disease rises inhaler technique in relation to age in patients with asthma and COPD.Those with COPD with age and this may be asymptomatic.Care should be exercised when administering a were older and less likely to be able to use an inhaler correctly than asthmatic patients, but nebulised agonist to a patient with known ischaemic heart disease and the first dose age was not an independent factor in predicting inability to use an inhaler.should be given in the lung function laboratory, ideally with an ECG recording before drug Age and strength might predict problems with competence in inhaler technique in the administration.The incidence of dysrrhythmias following nebulised agonists is well general asthmatic population, but in an elderly cohort of patients age becomes much less im-recognised 9 10 and has been reported to be as Frenchay Hospital, portant than cognitive function.In a group of high as 65% in patients with acute bronchial Bristol BS16 1LE, UK J C Pounsford patients aged over 75 years who had previously asthma.No significant difference in the incidence of dysrrhythmia was seen in a group been taught to use their inhalers correctly, 4