[Asthma in the elderly]

Abstract

Since the induction of inhaled corticosteroids as a first line therapy for asthma, severe intrac- table asthma had been decreased. Nonetheless, a proportion of severe asthma still remains including asthma in the elderly. To date, the reasons of severity in elderly asthma are con- sidered due to decline of pulmonary function and low adherence to the therapy, both of which are associated with aging. Airway inflammation is also different between younger and elderly asthma. Neutrophilic inflammation is predominant in the elderly asthma possibly due to imnu- nosenescence and asymptomatic aspiration. Inhaled corticosteroids possess a first line therapy for elderly asthma, while additional treatments for neutrophilic inflammation should be consid- ered including long acting bronchodilator and macrolide antibiotics. Similarly non pharma- cological assessment such as vaccine and smoking cessation are also important for elderly asthma.