Asthma Management in Older Adults
Summary
Asthma in older adults is increasingly recognised as a distinct clinical entity characterised by diverse phenotypes, comorbidities and altered treatment responses. Age-related changes in airway structure, immune function and lung mechanics contribute to a higher prevalence of fixed airflow limitation, neutrophil-predominant inflammation and reduced reversibility compared with younger patients. Immunosenescence and chronic low-grade inflammation intensify symptoms and may diminish responsiveness to standard anti-inflammatory therapies. Coexisting conditions such as cardiovascular disease, diabetes and gastro-oesophageal reflux complicate both diagnosis and management, heightening the risk of adverse drug interactions and hospitalisation. Under-recognition, misdiagnosis as chronic obstructive pulmonary disease and exclusion of older patients from clinical trials have left significant gaps in evidence for optimal care. A multidimensional approach that integrates thorough assessment of lung function, comorbidity profiling, inhaler technique review and tailored pharmacological regimens is essential. Non-pharmacological strategies, including pulmonary rehabilitation, vaccination and education on trigger avoidance, support better control and quality of life. As the population ages globally, refinement of age-specific guidelines and incorporation of geriatric principles into asthma care pathways will be critical to reduce morbidity and healthcare burden.
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Asthma Management in Older Adults publication trend
The graph below shows the total number of articles in asthma management in older adults across all publications each year (not limited to Nature Index journals).
Technical terms
Corticosteroid insensitivity: Reduced anti-inflammatory response in airway tissues despite standard steroid dosing.
Immunosenescence: Age-associated decline in immune regulation leading to altered inflammatory profiles.
Airway hyperresponsiveness: Exaggerated bronchoconstriction in response to stimuli such as allergens or cold air.
Asthma phenotype: Observable clinical and biological characteristics that define subtypes of the disease.
Neutrophilic inflammation: Predominance of neutrophils in airway secretions, often linked to more severe or steroid-resistant asthma.
Comorbidity: Coexisting medical condition that can influence asthma severity, treatment choices and outcomes.
References
- Aging-Related Mechanisms Contribute to Corticosteroid Insensitivity in Elderly Asthma. International Journal of Molecular Sciences (2023).
- Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study. The Journal of Allergy and Clinical Immunology In Practice (2022).
- Asthma in elderly is characterized by increased sputum neutrophils, lower airway caliber variability and air trapping. Respiratory Research (2021).
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