title: Diagnosis and management of asthma in older adults.
abstract: Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.
authors.affiliation: Department of Medicine, Respiratory Research Division, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland. schotirmall@rcsi.ie
authors.forename: Sanjay Haresh
authors.initials: SH
authors.lastname: Chotirmall
authors.forename: Michael
authors.initials: M
authors.lastname: Watts
authors.forename: Peter
authors.initials: P
authors.lastname: Branagan
authors.forename: Ciaran F
authors.initials: CF
authors.lastname: Donegan
authors.forename: Allan
authors.initials: A
authors.lastname: Moore
authors.forename: Noel Gerard
authors.initials: NG
authors.lastname: McElvaney
mesh_terms: D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D016503:Drug Delivery Systems; D006801:Humans; D012129:Respiratory Function Tests
chemical_list: D018927:Anti-Asthmatic Agents