Asthma in people over the age of 60 is frequently overlooked, misdiagnosed and inadequately treated — especially among those over 80. This is according to a large, multicenter study that highlights significant gaps in care for older adults living with the chronic respiratory disease.
Polish researchers tackled the topic of concern in the paper, “Asthma in Individuals Over 60 Years: A Comparative Analysis Across Age Subgroups,” recently published in the Journal of Allergy and Asthma. More than 750 adults across southern Poland were evaluated in the study, which found that one in four patients with asthma over the age of 60 had severe disease. Many individuals experienced poor symptom control, reduced quality of life and multiple untreated or overlapping health conditions. According to the study’s authors, the findings suggest that age-related diagnostic challenges and conservative treatment approaches leave some of the most vulnerable patients at risk of worsening health outcomes.
The study reported statistics from prior studies that said asthma affects an estimated 7-10% of people older than 60-65 years old, globally. These adults are often hiding in plain sight, the study’s authors suggested, noting that symptoms such as breathlessness and cough are frequently attributed to aging, heart disease or COPD rather than asthma itself.
Participants underwent detailed clinical evaluations, lung function testing and standardized questionnaires assessing asthma control and quality of life. According to researchers, the results showed that asthma later in life is not only common but complex.
Patients over 80 years old fared the worst, according to the study. They showed significantly poorer asthma control and lower scores on the widely used SF‑36 quality‑of‑life scale, compared to younger seniors. Their overall health perception scores averaged 46.9, well below the normative value of 50 and significantly lower than scores among patients in their 60s and 70s.
Across all age groups, the study’s authors reported that asthma patients reported worse quality of life than their non‑asthmatic peers. On the Asthma Quality of Life Questionnaire, the asthma group scored an average of 3.78 out of 7, compared with 4.29 in the control group.
Poorer quality of life was closely linked to worse asthma control — but not necessarily to standard lung function measures such as FEV₁, researchers wrote, suggesting that symptoms and daily functioning may deteriorate even when spirometry appears relatively preserved.
Making a clear diagnosis of asthma in older adults remains a major challenge, according to researchers. Many patients underreport symptoms or struggle to perform standard spirometry due to frailty, poor coordination or cognitive impairment. Others are mistakenly diagnosed with COPD or heart failure, conditions that can mimic asthma symptoms.
Additionally, participants with asthma had significantly higher rates of depression, cognitive decline and overall multimorbidity compared with non‑asthmatic participants, according to the study’s findings. Researchers underscored the need for clinicians to consider these overlapping conditions when considering both diagnosis and treatment.
To address testing limitations, the study evaluated the forced oscillation technique (FOT) — a simpler breathing test that requires minimal patient effort. Researchers found FOT particularly useful when spirometry results were unreliable, pointing to its potential role in diagnosing asthma in very old or frail patients.
Researchers did note that despite receiving care in specialized outpatient clinics, many patients — especially the oldest in the study — were undertreated. The analysis found that inhaled corticosteroid doses were significantly lower in older age groups, even though poorer asthma control was more common in those patients.
At the same time, researchers noted an uptick in reliance on short‑acting beta‑agonists and intermittent oral steroids. Only a small number of patients qualified for or received modern biologic therapies, despite a large proportion showing evidence of type 2 (T2) inflammatory asthma — a form known to respond well to targeted treatments, according to the study’s authors. They also warned that this pattern increases the risk of exacerbations and steroid‑related side effects while failing to adequately control the disease.
Ultimately, the study’s authors urged clinicians to move beyond a one‑size‑fits‑all approach. They encouraged clinicians to consider age‑specific challenges, routinely assess asthma phenotypes, address comorbidities and use alternative lung function tests when necessary.
Researchers concluded with a reminder that as populations continue to age, improving asthma recognition and treatment in older adults is not just a clinical priority but a public health necessity.
