Diagnosis and Management of Asthma in Older Adults

Abstract

Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.

Patient-reported respiratory symptoms and pre-bronchodilator airflow limitation among smokers in Switzerland

“…Patients with a longstanding history of asthma often show limited reversibility as a result of chronic airway inflammation, or both diseases may be present in the same patient. 20 Patient history, including symptoms, development over time, exposure, atopy and family history, will therefore often contribute more to the correct diagnosis than lung function testing alone. 20,22 Furthermore, smoking is an independent risk factor for asthma as well as COPD, and patients with or without airflow limitation should benefit from smoking cessation intervention.…”

“…19 The use of reversibility testing alone to differentiate between asthma and COPD is not appropriate. 20 Some older patients with asthma may have beta-adrenergic dysfunction and therefore will respond poorly to short-acting beta-adrenergic bronchodilators 21 whereas others need a prolonged course with oral steroids 20 in order to show improvement in lung function. Patients with a longstanding history of asthma often show limited reversibility as a result of chronic airway inflammation, or both diseases may be present in the same patient.…”

Advances in the Diagnosis and Management of Asthma in Older Adults

“…older patients because of the effects of age-related changes in lung function on respiratory physiology (8) . Aging leads to an obstructive defect on pulmonary function testing that may be challenging in distinguishing from a superimposed active disease process such as asthma.…”

“…One major differentiation of relevance to the older patient is that between longstanding and late-onset asthma (8) . (Tables 1 & 2).…”

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

“…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].…”