Optimizing asthma care in the elderly: A guidelines-based therapeutic approach for enhanced diagnosis and management

Asthma is a chronic inflammatory disease predominantly affecting the airways, leading to symptoms that include wheezing, breathlessness, and chest tightness. However, in the elderly-patient population, which forms about 7-10% of asthma cases, the condition presents quite differently because of physiological changes with age, additional comorbidities, and pharmacological sensitivities. Symptoms overlap with other conditions such as COPD, compounded by smoking history and cognitive decline, add to the complexity when it comes to diagnosing asthma in this age group. Spirometry and the bronchodilator reversibility test are very essential pulmonary function tests whose underutilization in this age group culminates in under-diagnosis and suboptimal management. Management of asthma in the elderly should be carefully planned in accordance with well-established protocols like those proposed by the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP). Those guidelines recommend the use of ICS and LABAs as core therapy with adjustments made for physiological and pharmacokinetic changes in older adults. While the pharmacological interventions will need more attention, prevention of exacerbations will be linked with non-pharmacological interventions that include lifestyle modification and vaccination. Polypharmacy and increased risk of adverse drug reactions further complicate treatment, but in most cases, require individualized care plans to reduce risks and increase results. This review puts emphasis on adherence to guideline-based therapeutic strategies and calls for future research efforts to be focused on age-specific clinical trials and biologic therapies directed to the elderly.By addressing the complexities of asthma in elderly patients, healthcare providers can enhance disease management and improve the quality of life for this vulnerable population.