Asthma in the elderly

Asthma is more prevalent and more severe in older individuals. Here, we review the literature on asthma in the elderly, with special focus on the pathophysiologic and immunologic mechanisms, healthcare utilization, the role of menopause and obesity, and the impact of chronic asthma on biological aging. Aging of the lung is characterized by constant decline in lung function, which is accelerated by occupational or tobacco exposure and pollution that may contribute to new onset asthma or greater severity of asthma in the elderly. Gender and sex hormones are critical determinants of asthma severity, such that perimenopausal women have more severe asthma, but postmenopausal women are protected from asthma. Immunosenescence places older adults at risk for infections, which may lead to airway hyper-reactivity and asthma exacerbations. Furthermore, the chronic low-level inflammatory state of aging is associated with decreased function of regulatory T (Treg) cells, which are important to resolve inflammation. The rate of obesity increases with age, and obesity independently places individuals at higher risk for asthma. Recent provocative studies suggest that asthma is characterized by accelerated molecular aging as defined by shorter leukocyte telomere lengths. Overall, older asthmatics suffer from greater morbidity, mortality, and healthcare utilization. More studies of the older asthmatic are needed to understand mechanisms and identify times for intervention to improve asthma control and outcomes. © 2015 Springer Science+Business Media New York.