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Clin Mol Allergy. 2015 Jun 22;13(1):7. doi: 10.1186/s12948-015-0016-x. eCollection 2015.

Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly.

Author information

1
Department of Medicine, University of Palermo, via Trabucco 180, 90146 Palermo, Italy.
2
Interdisciplinary Department of Medicine, Unit of Geriatric Immunoallergology, University of Bari, Bari, Italy.
3
Lung Function Unit, Department of Public Health and Infectious Diseases "Sapienza", University of Rome, Rome, Italy.
4
Respiratory Diseases & Allergy Clinic, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
5
Pneumology Unit, Department of Medical Sciences, University of Turin, AOU San Giovanni Battista, Torino, Italy.
6
Allergy Unit, Verona University and General Hospital, Verona, Italy.
7
Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
8
Department of Clinical and Experimental Medicine - Respiratory Medicine & Allergy, University of Catania, Catania, Italy.
9
Departmental Unit of Allergology-Clinical Immunology & Pneumology, Fondazione Poliambulanza, Brescia, Italy.
10
Centre of Excellence DENOTHE, Dept. of Experimental and Clinical Medicine, Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
11
Struttura Complessa di Pneumologia, ASL2 Savonese, Savona, Italy.
12
Laboratory of Immunology and Allergy, Department of Medicine and Sciences of Aging, University of G. d'Annunzio, Chieti Scalo, Italy.
13
Division of Allergy and Clinical Immunology, ASL SALERNO, Hospital of Battipaglia, 84100 Salerno, Italy.
14
Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
15
Allergologia e Immunologia Clinica, AO Ordine Mauriziano & University of Torino, Torino, Italy.
16
Units of Immunoallergology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
17
Università Cattolica del Sacro Cuore, Policlinico A.Gemelli, Rome, Italy.
18
Division of Pneumology, Spedali Civili di Brescia, Brescia, Italy.
#
Contributed equally

Abstract

The prevalence of asthma in the most advanced ages is similar to that of younger ages. However, the concept that older individuals may suffer from allergic asthma has been largely denied in the past, and a common belief attributes to asthma the definition of "rare" disease. Indeed, asthma in the elderly is often underdiagnosed or diagnosed as COPD, thus leading to undertreatment of improper treatment. This is also due to the heterogeneity of clinical and functional presentations of geriatric asthma, including the partial loss of reversibility and the lower occurrence of the allergic component in this age range. The older asthmatic patients are also characterized the coexistence of comorbid conditions that, in conjunction with age-associated structural and functional changes of the lung, may contribute to complicate the management of asthma. The current review addresses the main issues related to the management of allergic asthma in the geriatric age. In particular, the paper aims at revising current pharmacological and non pharmacological treatments for allergic asthmatics of advanced ages, primarily focusing on their safety and efficacy, although most behaviors are an arbitrary extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. Experimental studies and real life observations specifically testing the efficacy and safety of therapeutic approaches in allergic asthma in the elderly are urgently needed.

KEYWORDS:

Aging; Allergy; Asthma; Therapy

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