Table I.
Identified future research needs
| The aging lung |
| Large, longitudinal, and more complete studies to determine the effects of aging on the function of the respiratory system |
| Improved knowledge about lung structure-function relationships in older age using techniques of imaging and measures of lung function not requiring effort (eg, high-resolution computed tomographic scanning and forced oscillation) |
| Improved assessment of lung processes underlying airflow limitation attributable to aging versus COPD or asthma, especially in asthmatic patients who smoke |
| Studies to examine the effects of aging in ethnic groups and the role of gender |
| Epidemiology, effect, diagnosis, and management |
| Determine the true prevalence and cost of asthma in the older population |
| Develop a uniform definition of asthma to be applied to health care records that will distinguish asthma from COPD and mixed asthma/COPD |
| Evaluate evidence-based treatment algorithms for older asthmatic patients, such as those developed by the National Heart, Lung, and Blood Institute and Global Initiative For Asthma guidelines7 |
| Assess the effect of asthma treatment, including direct medical costs of care, indirect costs of care, and value of treatment in improving quality of life8, 9 |
| Assess the effect of comorbid conditions, especially COPD and congestive heart failure, on asthma9 |
| Characterize phenotypes of elderly asthma with regard to responses to therapy and long-term outcomes based on age of onset, duration of disease, and environmental triggers |
| Develop algorithms for electronic medical record systems that are asthma-specific |
| Evaluate effects of current asthma medications in older patients compared with younger patients |
| Identify pharmacogenetic determinants of response to asthma medications in older adults |
| Identify simpler and safer drug delivery systems and schedules for older adults |
| Develop simple methods to differentiate COPD from asthma exacerbations in older adults |
| Epigenetics and environmental and microbiological triggers |
| Understand how environmental or aging-related factors affect epigenetic changes in asthma in older adults |
| Identify differences between older and younger asthmatic patients or between LSA and LOA with regard to inflammation, remodeling, intracellular mechanisms, responses to environmental pollutants, and allergy sensitization and their effects on the metabolism and action of asthma drugs |
| Identify naturally occurring age-related changes in airway cellular patterns |
| Develop animal models of age-related airway inflammation |
| Understand the significance of allergy sensitization associated with asthma in older adults (eg, through larger prospective studies) |
| Identify the utility of allergy tests, either skin tests or serum specific IgE measurement, in reflecting allergy sensitization in older adults |
| Identify the role of the microbiome in patients with LOA |
| Understand the role of non-IgE mechanisms in older adults’ inflammatory responses to inhalant allergens or pollutants (eg, TH17 lymphocytes producing IL-17 or protease receptor responses to molds and dust mites) |
| Determine the roles of adaptive versus innate immune mechanisms on asthma development, progression, and response to treatment in older adults |
| Determine whether there are environmental pollutants peculiar to institutional settings |
| Identify viruses and other microbiological agents responsible for, and the mechanisms by which they cause, asthma exacerbations in older adults, which might lead to the development of vaccine- or antiviral drug–based interventions |
| Determine effects of asthma medications, viral or bacterial load, or allergy status on susceptibility to exacerbations in older patients |
| Define rates of infection and specific pathogens in older asthmatic patients |
| Distinguish roles of innate immunity in eosinophilic versus neutrophilic asthma |