Late-onset asthma: making the diagnosis, choosing drug therapy

Physicians often fail to diagnose asthma in their older patients and instead attribute respiratory symptoms to aging alone or to other common diseases of the elderly. Although asthma is a common respiratory disease in older patients, its pathophysiology is poorly understood. Most elderly asthmatics are former smokers and have evidence of allergic disease. Asthma itself does not appear to increase mortality risk for the older patient. Spirometric results may show mild reversible airflow obstruction or fixed obstruction. The recommended therapy in the older patient follows that used for younger asthmatics. Inhaled corticosteroids are first-line agents, followed by inhaled anticholinergics. Smoking cessation, proper nutrition, and exercise are important nondrug therapies.