[The epidemiology of asthma in the elderly. Apropos of a review of the literature]

Abstract

Increased longevity and the maintenance of autonomy in the elderly has lead to an enlargement of the study of asthma beyond 65 years. If the majority of published work in the literature concludes there is an excess mortality in the elderly asthmatic one cannot exclude the possibility that this excess mortality is due to the association, at this age, of asthma with other respiratory problems. This association would also explain the great variations in prevalence reported by different authors, from 3 to 6% with notable differences according to the sex. Bronchial reactivity appears to be less linked to allergy after 65 than in the young subject. In the elderly asthmatic the frequency of a past history of allergy and of positive cutaneous tests are weaker than in the young, and there is little difference when compared to the non-asthmatic subject. On the other hand the majority of studies show that smoking, respiratory infections, and social class are particularly linked to asthma beyond the age of 65. Although the data on predictive factors may be rare and contradictory certain published works suggest that deterioration in respiratory function most often precedes the appearance of symptoms suggesting the diagnosis. Many uncertainties remain in relation to asthma in the elderly. This is because in large part there are insufficiently specific identifying criteria. There is a need to develop standardised methods of evaluating respiratory handicap, notably specific data on the quality of life as this would be indispensable in evaluating the consequence of asthma in the elderly subject.