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Am J Med. 2009 Feb;122(2):109-13. doi: 10.1016/j.amjmed.2008.09.019. Epub 2008 Dec 26.

Asthma in US seniors: part 2. Treatment. Seeing through the glass darkly.

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Divisions of Clinical Immunology-Allergy and Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.



We sought to identify the best evidence for treatment of asthmatic patients aged 65 years or more.


We used computer-assisted searches to identify randomized, controlled trials for asthma in the elderly that were published in English between 1950 and 2008.


Small trials of an inhaled corticosteroid versus a leukotriene antagonist and an oral beta(2)-agonist versus placebo compose the controlled trial data on asthma therapy in seniors. Epidemiologic evidence suggests that the side effects of corticosteroids and beta-agonists may be more common in the elderly than in younger populations.


Seniors with asthma or comorbid conditions that are common in the elderly have been systematically excluded from asthma treatment trials. There is no compelling evidence to demonstrate the superiority of any pharmacologic therapy in these asthmatic patients. Evaluation of response to asthma treatment in clinical trials remains primarily symptom-based when symptoms have been shown to underestimate the severity of disease in seniors.

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