From the Guidelines
Yes, other lung diseases should be investigated in a 70-year-old man with a new diagnosis of asthma. This is particularly important because new-onset asthma in older adults often warrants consideration of alternative or concurrent diagnoses, as suggested by the British guideline on the management of asthma 1. The differential diagnosis should include chronic obstructive pulmonary disease (COPD), heart failure, gastroesophageal reflux disease, bronchiectasis, lung cancer, and interstitial lung disease. Evaluation should include comprehensive pulmonary function testing with bronchodilator response, chest imaging (typically a chest X-ray initially, with consideration of CT scan), and possibly cardiac evaluation, as recommended by the expert panel report 3 (EPR-3) 1.
Some key points to consider in the evaluation include:
- Smoking history
- Occupational exposures
- Medication use that might contribute to symptoms
- Presence of atypical symptoms, which should prompt a chest x-ray, as suggested by the British guideline on the management of asthma 1
- The need for a detailed medical history and physical examination to increase the probability of asthma, but also to consider other diagnoses, as outlined in the EPR-3 1
The investigation is crucial because misdiagnosis can lead to inappropriate treatment and missed opportunities for disease-specific interventions. For example, treating COPD requires different medication approaches than asthma alone, and missing an underlying malignancy could delay necessary treatment, as highlighted in the EPR-3 1. Additionally, older adults often have multiple comorbidities that can complicate both diagnosis and management of respiratory symptoms, making thorough evaluation essential for optimal care.
From the Research
Diagnosis and Investigation of Asthma in 70-Year-Old Men
When diagnosing asthma in 70-year-old men, it is essential to consider the possibility of other lung diseases, such as Chronic Obstructive Pulmonary Disease (COPD). The following points highlight the importance of investigating other lung diseases in this population:
- Asthma and COPD can coexist, and their symptoms can overlap, making diagnosis challenging 2.
- Spirometry with bronchodilator reversibility testing is the mainstay of asthma diagnostic testing, but it may not be sufficient to differentiate between asthma and COPD 3, 4.
- A comprehensive diagnostic approach, including patient history, spirometry, and other lung function tests, can help differentiate between asthma and COPD 4.
- Other lung diseases, such as heart failure, can also coexist with asthma and COPD, and their diagnosis requires a combination of clinical evaluation, pulmonary function testing, and echocardiography 2.
Importance of Investigating Other Lung Diseases
Investigating other lung diseases in 70-year-old men with a new diagnosis of asthma is crucial because:
- COPD is more common in older adults, and its diagnosis can be missed if not properly investigated 5, 2.
- Heart failure can coexist with COPD and asthma, and its diagnosis requires a comprehensive evaluation 2.
- Accurate diagnosis of asthma and other lung diseases is essential for effective management and treatment, as different diseases require different therapeutic approaches 3, 6.
Diagnostic Approach
A diagnostic approach that includes the following steps can help investigate other lung diseases in 70-year-old men with a new diagnosis of asthma:
- Patient history and physical examination to identify symptoms and signs of other lung diseases 2, 4.
- Spirometry with bronchodilator reversibility testing to assess airway obstruction and reversibility 3, 4.
- Other lung function tests, such as peak flow measurement and bronchial challenge testing, to confirm airway obstruction and variability 3, 4.
- Echocardiography and other diagnostic tests to evaluate for heart failure and other comorbidities 2.