Asthma in older adults

Asthma is frequently overlooked in the geriatric population, as in the present review by Meyer S. Balter and colleagues.¹ Asthma in older adults is associated with a significant number of hospitalizations and emergency department visits, which lead to substantial amounts of health care costs. Even when discovered, it is often undertreated.² The hallmark symptoms of asthma, including episodic shortness of breath, wheeze and cough, are nonspecific in older adults and are mimicked by other diseases, such as congestive heart failure, emphysema and chronic bronchitis, chronic aspiration, gastroesophageal reflux disease and tracheobronchial tumours. Several things must be taken into account when considering appropriate pharmacologic therapy in older patients, including poor inhaler technique, differences in pharmacodynamics and pharmacokinetics than in the younger population, diminished response to β₂-agonists, comorbidities, complex regimen, prohibitive cost and poor memory.