title: Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly.
abstract: The prevalence of asthma in the most advanced ages is similar to that of younger ages. However, the concept that older individuals may suffer from allergic asthma has been largely denied in the past, and a common belief attributes to asthma the definition of "rare" disease. Indeed, asthma in the elderly is often underdiagnosed or diagnosed as COPD, thus leading to undertreatment of improper treatment. This is also due to the heterogeneity of clinical and functional presentations of geriatric asthma, including the partial loss of reversibility and the lower occurrence of the allergic component in this age range. The older asthmatic patients are also characterized the coexistence of comorbid conditions that, in conjunction with age-associated structural and functional changes of the lung, may contribute to complicate the management of asthma. The current review addresses the main issues related to the management of allergic asthma in the geriatric age. In particular, the paper aims at revising current pharmacological and non pharmacological treatments for allergic asthmatics of advanced ages, primarily focusing on their safety and efficacy, although most behaviors are an arbitrary extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. Experimental studies and real life observations specifically testing the efficacy and safety of therapeutic approaches in allergic asthma in the elderly are urgently needed.
authors.affiliation: Department of Medicine, University of Palermo, via Trabucco 180, 90146 Palermo, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Scichilone
authors.affiliation: Interdisciplinary Department of Medicine, Unit of Geriatric Immunoallergology, University of Bari, Bari, Italy.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Ventura
authors.affiliation: Lung Function Unit, Department of Public Health and Infectious Diseases "Sapienza", University of Rome, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bonini
authors.affiliation: Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Braido
authors.affiliation: Pneumology Unit, Department of Medical Sciences, University of Turin, AOU San Giovanni Battista, Torino, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Bucca
authors.affiliation: Allergy Unit, Verona University and General Hospital, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Caminati
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Giacco
authors.affiliation: Department of Clinical and Experimental Medicine - Respiratory Medicine & Allergy, University of Catania, Catania, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Heffler
authors.affiliation: Departmental Unit of Allergology-Clinical Immunology & Pneumology, Fondazione Poliambulanza, Brescia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Centre of Excellence DENOTHE, Dept. of Experimental and Clinical Medicine, Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Matucci
authors.affiliation: Struttura Complessa di Pneumologia, ASL2 Savonese, Savona, Italy.
authors.forename: Manlio
authors.initials: M
authors.lastname: Milanese
authors.affiliation: Laboratory of Immunology and Allergy, Department of Medicine and Sciences of Aging, University of G. d'Annunzio, Chieti Scalo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Paganelli
authors.affiliation: Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Passalacqua
authors.affiliation: Division of Allergy and Clinical Immunology, ASL SALERNO, Hospital of Battipaglia, 84100 Salerno, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Patella
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Erminia
authors.initials: E
authors.lastname: Ridolo
authors.affiliation: Allergologia e Immunologia Clinica, AO Ordine Mauriziano & University of Torino, Torino, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rolla
authors.affiliation: Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Rossi
authors.affiliation: Università Cattolica del Sacro Cuore, Policlinico A.Gemelli, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Schiavino
authors.affiliation: Allergy Unit, Verona University and General Hospital, Verona, Italy.
authors.forename: Gianenrico
authors.initials: G
authors.lastname: Senna
authors.affiliation: Division of Pneumology, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Gundi
authors.initials: G
authors.lastname: Steinhilber
authors.affiliation: Centre of Excellence DENOTHE, Dept. of Experimental and Clinical Medicine, Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Vultaggio
authors.affiliation: Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Canonica
keywords: Aging; Allergy; Asthma; Therapy