Asthma is a chronic airway disease that affects all ages, but does this definition also include the
elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological
studies and clinical experience support the concept that asthma is as prevalent in older age as it
is in the young. With the ever-increasing elderly population worldwide, the detection and proper
management of the disease in old age may have a great impact from the public health perspective.
Whether asthma in the elderly maintains the same characteristics as in young populations is an
interesting matter. The diagnostic process in older individuals with suspected asthma follows the
same steps, namely a detailed history supported by clinical examination and laboratory investigations;
however, it should be recognised that elderly patients may partially lose reversibility of
airway obstruction. The correct interpretation of spirometric curves in the elderly should take into
account the physiological changes in the respiratory system. Several factors contribute to delaying
the diagnosis of asthma in the elderly, including the age-related impairment in perception of
breathlessness. The management of asthma in advanced age is complicated by the comorbidities
and polypharmacotherapy, which advocate for a comprehensive approach with a multidimensional
assessment. It should be emphasised that older age frequently represents an exclusion
criterion for eligibility in clinical trials, and current asthma medications have rarely been tested
in elderly asthmatics. Ageing is associated with pharmacokinetic changes of the medications.
As a consequence, absorption, distribution, metabolism and excretion of antiasthmatic medications
can be variably affected. Similarly, drug-to-drug interactions may reduce the effectiveness
of inhaled medications and increase the risk of side-effects. For this reason, we propose the term
“geriatric asthma” be preferred to the more generic “asthma in the elderly”.