Hypercapnia and oxygen therapy in older asthmatic patients

Excessive oxygen administration in hypercapnic chronic obstructive pulmonary disease predisposes to worsening respiratory failure during intercurrent respiratory illness. Chronic hypercapnia is thought to downregulate carbon dioxide chemoreceptor sensitivity, adversely affecting respiratory function/mechanics and worsening ventilation-perfusion inequality. These patients are dependent on hypoxic drive to maintain adequate spontaneous respiration. Whether an analogous situation occurs in asthma in older adults is unknown. These conditions may be difficult to differentiate clinically, and both may respond adversely to the administration of excessive oxygen in the presence of chronic hypercapnia. Although unrestricted oxygen is beneficial and safe in children and young adults with asthma, it may lead to progressive hypercapnia in older patients with asthma, a potential risk highlighted by this case. To avert progressive hypercapnia, oxygen therapy that is carefully adjusted to achieve adequate, but not maximal, tissue oxygenation may be a safer strategy than unrestricted oxygen use in older asthmatic patients. However, the correction of hypoxia overrides strategies to avert oxygen-related hypercapnia.