Asthma in the Elderly

Abstract

In children and young adults, asthma often presents many of the following features: atopy is common; airflow obstruction is fully reversible; differential diagnoses are few (except in the very young); and concomitant illnesses are uncommon. Although asthma in the elderly (meaning, for the purposes of this discussion, age 65 years and older) may share all of these characteristics, exceptions become increasingly common with advancing age. In older persons, the prevalence of allergic asthma (as defined by skin test sensitivity) is relatively small; fixed airflow obstruction may be present during clinical remissions of asthma; the differential diagnosis of new-onset wheezing is broad; and comorbid disease, especially coronary artery disease, often complicates both diagnosis and therapy. Even the definition of asthma becomes somewhat obscured in an older population: persons with chronic bronchitis and emphysema who exhibit episodic dyspnea and wheezing and a reversible component to their airflow obstruction challenge our nosology. One must attempt to decide whether their asthmaticlike condition, often referred to as “asthmatic bronchitis,” is the same illness that we call asthma. Thus, although in some instances asthma in the elderly is simply a continuation of this chronic condition into old age, in others it raises a host of special diagnostic and therapeutic considerations.