Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

Prospective study in an 1,800-bed teaching hospital.Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years) were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137) and the cardiac asthma group (n = 75), differed for tobacco use (34% vs. 59%, p < 0.05), history of chronic obstructive pulmonary disease (16% vs. 47%, p < 0.05), peripheral arterial disease (10% vs. 24%, p < 0.05). Patients with cardiac asthma had a significantly lower pH (7.38 ± 0.08 vs. 7.43 ± 0.06, p < 0.05), and a higher PaCO2 (47 ± 15 vs. 41 ± 11 mmHg, p < 0.05) at admission. In the cardiac asthma group, patients had greater distal airway obstruction: forced expiratory volume in 1 second of 1.09 vs. 1.33 Liter (p < 0.05), and a forced expiratory flow at 25% to 75% of vital capacity of 0.76 vs. 0.99 Liter (p < 0.05). The in-hospital (23% vs. 19%) and one year mortality (48% vs. 43%) rates were similar.Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.In Western countries, the population is getting older, and it is projected that there will be a doubling of individuals over the age of 65 and 80 years by 2030 [1]. It is estimated that about 10% of the population over the age of 80 years have heart failure [1]. Congestive heart failure (CHF) is the leading cause of acute dyspnea in elderly patients, with an in-hospital mortality ranging from 13 to 29 % [2-8]. CHF presenting with wheezing is termed cardiac asthma [9,10]. Although airflow obstruction in the setting of cardiogenic pulmonary edema (CPE) has long been familiar to clinicians, the mechanisms responsible for this observation