Challenges in the Management of Asthma in Older Adults

Purpose of reviewAsthma is a heterogeneous and variable disease directly influenced by genetic factors, environmental triggers, and lung development throughout life. Elderly with asthma have unique needs not fully addressed by current guidelines. This present review aims to discuss the particularities of asthma in older adults and present an overview of tailored treatment strategies in the geriatric population. Recent findingsThe physiologic aging process promotes biological changes leading to dilatation of air spaces, deterioration of lung function, and dysregulation of the immune system. In advanced age, asthma manifests a specific phenotype with a greater propensity for small airway remodeling, downregulation of Th2-mediated allergic pathways, and higher mortality. Challenges regarding asthma management in older adults include the overlap of other prevalent morbid conditions, poor perception of asthma symptoms, technical issues in performing and interpreting lung function tests, and difficulties in using inhalation devices. Asthma education is essential to develop a collaborative patient-doctor partnership to improve clinical outcomes. Clinicians must encourage smoking cessation and exercise-based pulmonary rehabilitation.Older asthmatics are less likely to respond to traditional therapies, including inhaled corticosteroids. It is critical to understand the influence of geriatric factors on treatment effectiveness to optimize management of asthma in elderly patients