Drug treatment of asthma in the elderly

Asthma is a chronic inflammatory disease of the airways that may affect individuals at any age, and can be especially challenging to diagnose and treat in the elderly. The hallmarks of asthma--bronchial hyperreactivity and reversible airflow obstruction--lead to symptoms of intermittent wheezing, dyspnoea and cough. Occasionally, atypical symptoms such as chest pain or tightness occur and may mimic other diseases more common in the elderly, such as ischaemic heart disease. It is therefore important to use objective measures such as spirometry or bronchoprovocation testing to make a diagnosis. In recent years, trends in the treatment of asthma have changed from reliance on shorter-acting bronchodilating drugs to long term preventative therapy with inhaled corticosteroids. In some elderly asthmatic patients, symptoms may be mild and intermittent, and treatment with an inhaled beta 2-adrenergic agent may be all that is required. Most, however, experience persistent symptoms, and pharmacological therapy should begin with daily inhaled corticosteroids and be increased in a stepwise fashion according to the patient's needs. In such patients, short-acting beta 2-agonists should be continued as needed for acute symptomatic relief. Longer-acting beta 2-agonists, oral theophylline and inhaled anticholinergic therapy may be useful. When symptoms are more severe and potentially life-threatening, oral corticosteroids should be given. Since elderly patients are more likely to develop complications of asthma therapy and more likely to manifest adverse interactions with other therapeutic agents, more intense monitoring of asthma treatment is required in dealing with this population.