Confronting the challenges of asthma in the elderly patient

Asthma has long been underdiagnosed in the elderly. The classic symptoms-episodic wheezing, shortness of breath, and chest tightness-are nonspecific, particularly in this age group; and other diseases, such as chronic obstructive pulmonary disease, congestive heart failure, and angina, may have similar presentations. Also, older patients may underrate their symptoms. Objective measurements of lung function should always complement the history taking and physical examination. Baseline spirometry should be performed during the diagnostic workup, after initiation or change of therapy, during exacerbations, and at least once every 1 to 2 years thereafter. Management of asthma should include careful monitoring, control of triggers, optimization of pharmacotherapy, and provision of appropriate asthma education. The use of the newer breath-actuated devices, including dry-powder devices, may help optimize the delivery of medications, because these devices are generally easier to use by the elderly.