Is Asthma Control Really More Difficult to Achieve in the Elderly Patient?

prevalence of comorbidities and sometimes the complex polypharmacy prescribed also contribute to poor asthma control and/or medication-associated side effects in this population. In the past, elderly patients were usually excluded from studies on asthma, so there is an urgent need to look at the influence of age on the response to management strategies of this condition and at possible ways of reducing its burden. Multiple future research needs on this topic have been detailed in recent reports [4, 6] . In the study by Ponte et al. [9] recently published in this journal, 401 steroid-naïve patients, predominantly women and with mostly long-standing (particularly in the older patients), uncontrolled asthma, were followed up for 1 year. The authors conclude that older age at enrolment does not predict asthma control or emergency department (ED) visits at follow-up if asthma is treated properly, even when lung function is reduced. There was a notable median reduction of ED visits at follow-up (98%) in the group of subjects <55 years of age and in those >55 years (92%; p = 0.02), suggesting a marked effect of the proposed interventions. There was no significant difference between the 2 groups. Age did not predict symptom control, number of ED visits, hospital admissions or improvement in lung function at follow-up, and the intervention resulted in similar control and improvement in quality of life in both groups. In the above study, older subjects had poorer lung function and less severe rhinitis at the last visit (i.e. after 1 year). The observation of a poorer lung function in oldDespite significant advances in our understanding of asthma and the development of new treatments and management strategies, this common condition too often remains uncontrolled [1, 2] . This is particularly true for elderly asthmatic patients, who, compared to younger patients, show an increased asthma-related morbidity and mortality [3, 4] . Although often confounded with other conditions such as chronic obstructive pulmonary disease (COPD) or cardiac problems, asthma can affect between 4.5 and 12.7% of the elderly population [5, 6] . With the increasing life expectation observed in most countries, there is a marked interest to know more about how aging could influence respiratory health [4–6] . Aging influences not only respiratory function but also the immune response to infectious agents and the environment [7, 8] . It can also contribute to the modulation of pathological processes such as those associated with asthma or COPD, therefore influencing clinical features and treatment responses. In this regard, a specific phenotype of ‘asthma in the elderly’ is being increasingly characterized [4, 6] . However, not only can the normal physiological changes associated with age contribute to make asthma more severe, many management deficiencies have also been documented in elderly asthmatic patients. These include poor recognition of symptoms, poor adherence to therapy and difficulties associated with alterations in intellectual functioning, particularly memory, in addition to hearing loss, coordination problems affecting inhaler technique as well as psychological (e.g. depression) and socioeconomical problems. The increased Published online: December 2, 2014