Asthma in Older Adults: Clinical Patterns, Inflammatory Phenotypes, and Practical Management.

Abstract

Asthma in older adults is a common but frequently underrecognized condition associated with disproportionately high morbidity, health care utilization, and mortality. Older adults with asthma face distinct management challenges compared with younger patients, including age-related physiologic changes, multimorbidity, polypharmacy, impaired symptom perception, and difficulties with inhaler use, all of which complicate diagnosis and disease control. Aging is accompanied by immune remodeling characterized by immunosenescence and chronic low-grade inflammation (inflammaging), leading to altered airway inflammatory profiles. Compared with younger adults, aging-related changes may contribute to greater inflammatory heterogeneity in older adults with asthma, including neutrophilic or mixed type 2-low inflammation, although a subset retains classic type 2-high eosinophilic features. These differences have important therapeutic implications, because type 2-low inflammation is often less responsive to inhaled corticosteroids and conventional biomarker-guided approaches. Optimal management therefore requires recognition of these clinical and inflammatory differences. Treatment decisions should incorporate inflammatory phenotyping, biomarker interpretation, comorbidities, and functional status rather than age-neutral algorithms. This review summarizes key clinical and inflammatory features that distinguish older adults with asthma from younger adults and provides practical guidance for personalized, multidimensional asthma management to improve control and reduce exacerbations in this growing population.