Asthma in adults over age 60 remains significantly undertreated, leading to poorer disease control and diminished quality of life, particularly in patients over 80.


RT’s Three Key Takeaways:

  1. Diagnostic Limitations: The study found that traditional spirometry is often difficult for older adults to perform, making the forced oscillation technique a valuable alternative for identifying airway obstruction.
  2. Age-Related Control: Patients over age 80 demonstrated significantly worse asthma control and lower quality of life scores compared to patients in their 60s and 70s.
  3. Therapeutic Gaps: Researchers identified a trend of inadequate treatment in the elderly, characterized by lower doses of inhaled corticosteroids and limited access to biological medications.


Asthma in adults over age 60 remains significantly undertreated, leading to poorer disease control and diminished quality of life, particularly in patients over 80, according to a study published in the Journal of Asthma and Allergy.1

The multicenter, cross-sectional study analyzed 345 asthma patients and 410 matched controls to evaluate asthma control, phenotypes, and treatment patterns.1 The research team found that 25% of the study population had severe asthma, and 48% presented with the T2 phenotype.1

Challenges in Diagnosis and Management

The diagnosis of asthma in older populations is often complicated by atypical symptom presentation and comorbidities that overlap with respiratory issues. The study found that asthma patients had significantly higher rates of depression, cognitive decline, and multimorbidity compared to those without the condition.1

“Asthma in older age is often associated with other comorbidities, which can have a significant impact on a person’s quality of life and general health,” the researchers wrote in the study.1

Functional respiratory tests also presented challenges. Reliable spirometry can be difficult for seniors due to physical frailty, poor coordination, or cognitive impairment.1 The researchers noted that the forced oscillation technique (FOT) proved useful in assessing respiratory impedance when spirometry was limited.1 While patients over 80 achieved age-appropriate lung function less frequently during spirometry, no such differences were observed in resistance measurements via FOT.1

Treatment Disparities Among Age Subgroups

The analysis revealed significant differences in how asthma is managed across different age brackets. Patients in the oldest subgroup, those over age 80, received lower daily doses of inhaled corticosteroids (ICS) than younger patients. The median daily dose of ICS for the entire population was 605 micrograms of budesonide equivalent.1

The study also identified a high reliance on oral steroids and a low utilization of biological therapies. Despite the availability of biological drug programs, very few patients in the study were qualified for these treatments. Furthermore, the abuse of short-acting beta2 agonists was common in younger age groups within the study.1

Quality of Life and Healthcare Impact

Quality of life scores were consistently lower in the asthma group compared to the control group. In the oldest subgroup, scores on the 36-Item Short Form Survey were significantly worse regarding general health perceptions.1 Better asthma control, as measured by the Asthma Control Test, was strongly correlated with higher quality of life scores.1

The researchers suggested that the higher prevalence of dementia and depression in asthma patients may make it more difficult for them to verbalize health problems, contributing to underdiagnosis.1 They noted that the number of asthma patients over age 60 is likely underestimated globally.1

“Patients are often undertreated, which results in poorer asthma control, particularly among the oldest patients,” the researchers concluded, adding that healthcare providers should focus on personalized and age-adjusted treatment strategies to improve outcomes for this population.1


Reference

  1. Miodońska M, et al. Asthma in Individuals Over 60 Years: A Comparative Analysis Across Age Subgroups. Journal of Asthma and Allergy, 19. 2026. https://doi.org/10.2147/JAA.S561913