Asthma in older adults has similar clinical and physiologic consequences as seen with younger patients.
However, the physiological effects of aging and the presence of comorbid disease profoundly affect its
diagnosis, clinical presentation, and management.2 Normal aging causes a decline in lung function and
modifications in airway composition. Those airway changes include decreases in all of the following:
collagen content, airway diameter on expiration, pulmonary muscle strength, pulmonary function,
sensation/perception of dyspnea, cell immunity, and arterial partial pressure of oxygen.6 Though these
age-related changes are inevitable, they do not affect all patients to the same extent. When illness occurs,
age-related changes exaggerate the stress put on the patient’s oxygen reserve, further compromising the
respiratory system. Age-related changes also increase the patient’s risk of lower respiratory tract infections
and airway obstruction.6
The recognition of asthma phenotypes, the set of
observable characteristics of an individual resulting
from the interaction of his or her genotype with the
environment, has gained significant interest in recent
years.2 There are 2 identified phenotypes among
older adults with asthma: those with a long-standing
history of moderate to severe asthma that is only
partially reversible and those diagnosed with asthma
as an adult.2 Current asthma guidelines do not
differentiate asthma management between these
phenotypes in older adults.7