Advances in the Diagnosis and Management of Asthma in Older Adults

Abstract

Global estimates on ageing predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis and management in clinical practice require optimization. This review aims to provide an update for clinicians highlighting advances in the understanding of the ageing process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Ageing impacts airway responses, immune function and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence and side effect profiles persist in the older patient while novel recording devices developed to aid detection of an adequate inhalation evaluates treatment effectiveness and compliance more accurately than previously attainable. Anti-cytokine therapies improve control of brittle asthma while bronchial thermoplasty is an option in refractory cases. Multi-dimensional intervention strategies prove best in the management of asthma in the older adult which remains a condition that is not rare but rarely diagnosed in this patient population.

Efficiency of antifungal sublingual allergen-specific immunotherapy in patients under and over 50 years old with mild persistent and moderate bronchial asthma

“…Зростання числа хворих з поєднанням ГХ і хронічного обструктивного захворювання легень (ХОЗЛ) зумовлено як підвищенням захворюваності на ці захворювання, так і збільшенням геріатричної популяції хворих, у яких дана патологія дуже поши-рена [2]. Частота артеріальної гіпертензії в комбіна-ції з бронхіальною обструкцією наростає з віком [3].…”

Senescencia del sistema inmune y alteraciones relacionadas con el asma

“…De igual manera, las soluciones oftálmicas para el glaucoma pueden inducir episodios de asma. 83,84,85 Tanto el diagnóstico del asma, principalmente cuando inicia en edades avanzadas, como el tratamiento de la enfermedad en ellos, constituyen un reto. El diagnóstico se puede confundir con algunas entidades clínicas que prevalecen en el anciano y puede ser difícil realizar estudios como la espirometría, que pueden arrojar resultados falsos o de difícil interpretación, ya que además de la capacidad pulmonar, la función y fuerza de las estructuras toráci-cas están afectadas.…”

Aging and the microbiome: implications for asthma in the elderly?

“…Undoubtedly, genetic and environmental factors may also play key roles. The effects of immunosenescence and inflamm-aging on asthma in the elderly have been recognized but remain underexplored; however, association with a changing (and aging) microbiome is yet to be considered [2,8].…”

“…Immunosenescence reflects age-related declines in immune function at cellular and serological levels [2,4]. Specific responses to foreign and self-antigens ensue with an increased susceptibility of the elderly to infectious disease, poorer vaccine response and increased prevalence of cancer, autoimmune and other chronic disease.…”

“…Its recognition, diagnosis and treatment are complex, and challenges exist in performing and interpreting pulmonary function testing. Combined with specific therapeutic issues, asthma in the elderly represents a disease entity further affected by the physiological aging process that we review elsewhere [1,2].…”