Asthma Over the Age of 65: All's Well That Ends Well

Abstract

Asthma in older adults (often classified as those 65 years or older) is relatively common, underdiagnosed, and suboptimally treated. It is an important health problem, as the population of the United States continues to age. Unfortunately, asthma morbidity and mortality rates are highest in this age group. Alterations in the innate and adaptive immune responses occur with aging, and contribute to pathophysiologic differences and subsequent treatment challenges. The symptoms of asthma may differ from those in younger populations, and often include fatigue. There are unique factors that can complicate asthma management among older adults, including comorbidities, menopause, caregiver roles, and depression. Pharmacologic therapies are often not as effective as in younger populations, and may have greater side effects. Spirometry, peak flow measurements, and asthma education are typically underused, and may contribute to delays in diagnosis as well as worse outcomes. There are specific strategies that health care providers can take to improve the care of older adults with asthma.

Keywords: Asthma; Asthma COPD overlap syndrome; Depression; Education; Elderly; Immunosenescence; Menopause; Older adults; Spirometry.

Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Projected U.S. population ≥ 65 years. Projections based on 2015 analysis of U.S Census data by Population Reference Bureau

Figure 2

Mortality rates for asthma among different age groups (young children, adolescents, young adults, and older/very old adults). Adapted from: Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016

Figure 3

Impacts of immunosenescence and inflammaging on asthma. A list of corresponding citations is available online.