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Diagnosis and management of asthma in older adults

Author
Carlos A Vaz Fragoso, MD
Section Editors
Peter J Barnes, DM, DSc, FRCP, FRS
Kenneth E Schmader, MD
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Asthma is common in adults over age 65 [1,2]. It substantially reduces both psychological and physical quality of life among older adults [2-5].

Some experts distinguish two categories of asthma in older adults. The first category comprises older patients whose typical symptoms of asthma developed in childhood or early adulthood and persisted through later life. Normal lung function is usually interspersed with intermittent periods of airflow obstruction, although chronic airway remodeling may lead to airflow limitation that does not fully reverse. The second category, which is less common, comprises patients who first develop new symptoms of asthma as older adults. The diagnosis in the first category is usually reasonably clear. The diagnosis in the second category may be challenging due to the higher incidence of COPD and the longer list of differential diagnoses. We find these two categories helpful for the discussion of the disease, but acknowledge their limitations. The clinical course may be more complex; for example, childhood asthma usually remits in adolescence, but often reappears later in adulthood. Evidence is lacking for the definition of these categories and for treatment strategies based upon these categories.

The clinical manifestations, evaluation, and management of asthma in older adults will be reviewed here. General topics on the evaluation, diagnosis, and management of asthma and COPD are discussed separately. (See "Diagnosis of asthma in adolescents and adults" and "An overview of asthma management" and "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging" and "Management of stable chronic obstructive pulmonary disease".)

EPIDEMIOLOGY

The prevalence of asthma in adults age 65 and older is estimated at 4 to 8 percent [6,7]. The prevalence of asthma among all adults in the United States is estimated to be 7.7 percent [8]. A separate report estimated that over two million persons with asthma are aged ≥65 years [9]. The epidemiology of asthma in general is discussed separately. (See "Epidemiology of asthma".)

RISK FACTORS AND TRIGGERS

Potential risk factors and triggers for asthma in older adults are similar to asthma triggers in other age groups [10-16]. A questionnaire has been developed by the NAEPP to help clinicians assess the relationship between exposure to triggers and asthma symptoms (table 1). It is worthwhile to ask older patients with asthma about triggers, because more than one-third of older patients with asthma report exercise-induced asthma symptoms; half report that animal contacts, or exposure to dusts or fumes trigger their respiratory symptoms; and over two-thirds report seasonal worsening [2,17]. Asthma risk factors and asthma triggers are discussed in greater detail separately. (See "Risk factors for asthma" and "Trigger control to enhance asthma management".)

                                  

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