Asthma in older people

The prevalence of asthma in patients older than 65 years is the same as in the general adult population. Asthma first presenting in this age group is often called late-onset asthma.

Asthma may be harder to diagnose in older people because of under-reporting of symptoms that are assumed to be related to ageing and concurrent conditions (eg chronic obstructive pulmonary disease [COPD], heart failure, deconditioning). The coexistence of asthma (increased airflow variability) and COPD (incompletely reversible airflow limitation) is common in this age group; see Overlap of asthma and COPD.

Consider the potential for drug interactions and aggravation of pre-existing conditions (eg tachyarrhythmias, diabetes) when prescribing drugs for asthma.

Choose suitable inhaler devices and train patients in their use. For consideration of device choice in older adults, see here. If possible, avoid prescribing multiple different inhaler devices. Although poor inhaler technique is common in all patients, additional factors in older patients can contribute to poor technique, including mechanical difficulties (eg osteoarthritis), visual or cognitive impairment, and poor inspiratory flow.