Asthma Care in the Elderly: Practical Guidance and Challenges for Clinical Management - A Framework of 5 “Ps”

Abstract

Uncontrolled asthma in the elderly is a public health issue recognized in developed countries such as the United States and among the European Union, both from patient safety and economic perspectives. Variations in the cutoff, which defines elderly age, contribute to epidemiological study difficulties. Nonetheless, the relevance of elderly asthma from a socioeconomic perspective is inarguable. The projected growth of the enlarging geriatric population in the United States portends an impending national health burden that may or may not be preventable with pharmacologic and non-pharmacologic treatments. Asthma in the elderly might be a consequence of uncontrolled disease that is carried throughout a lifetime. Or elderly asthmatics could suffer from uncontrolled asthma, which overlaps with other ailments common with advancing ages that merit consideration, eg, COPD, heart disease, OSA, diabetes mellitus, and other comorbidities. Because of the heterogeneity of asthma phenotypes and other conditions that could mimic the symptoms of elderly asthma, further cohort studies are needed to elucidate the elderly asthmatic pathophysiology and management. More studies to characterize elderly asthma can help address these patients' unmet need for evidence-based guidelines. We introduce the 5 "Ps" (phenotypes, partnership, pharmacology, practice in acute exacerbations, and problems or barriers for the elderly asthmatics) that establish a framework approach for clinical practice.

Aging-Related Mechanisms Contribute to Corticosteroid Insensitivity in Elderly Asthma

“…Understanding the unique manifestation of elderly asthma can aid physicians in more effectively managing asthma and could lead to better therapeutic options. For additional insight into asthma management in elderly populations, we refer the reader to recent articles [ 105 , 106 , 107 ]. With the aging population continuing to increase, research efforts to understand asthma in the elderly and improve corticosteroid sensitivity remain important and need to be addressed by basic, translational, and clinical research.…”

Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges

“…Hence, healthcare providers must remain vigilant, considering the nuances of aging and its impact on asthma symptoms and treatment. Asthma management in elderly people should be personalized, considering individual health profiles and preferences [ 50 , 51 ]. Patient education is important, empowering the elderly to recognize symptoms, adhere to prescribed medications, and implement action plans, thereby enhancing their quality of life [ 52 , 53 ].…”

Effect of overweight/obesity on relationship between fractional exhaled nitric oxide and airway hyperresponsiveness in Chinese elderly patients with asthma

“… 1 Aging-related changes in immunity and respiratory physiology make elderly asthma patients more prone to erratic symptoms, numerous comorbidities, and increased mortality. 2 – 5 Obesity, another significant concern linked with aging, considerably influences asthma occurrence and manifestations. 6 Globally acknowledged as a distinct asthma phenotype, obesity-linked asthma can increase the patient’s risk by 1.51-fold over normal-weight individuals.…”

“…Our research delves into this underexplored area, focusing on the presumably non-allergic mechanisms of obesity-induced asthma in the elderly. 11 Evidence suggests that obesity is primarily associated with non-atopic asthma in adults, 3 , 4 and fractional exhaled nitric oxide (FeNO) measurement is an established marker of eosinophilic airway inflammation. 12 , 13 However, the obesity-asthma nexus, via non-eosinophilic airway inflammation in the elderly, is mostly unclear.…”