Corticosteroid Therapy of Asthma in Elderly: Choosing Wisely

Eko Surachmanto
Department of Internal Medicine
Faculty of Medicine University of Sam Ratulangi
Prof. Dr. R. D. Kandou General Hospital Manado

ABSTRACT
Asthma is a major global health problem. The prevalence of asthma differs geographically and
varies ranging from 4% to 13% in elderly and it is associated with higher morbidity and
mortality than asthma in younger subjects. Asthma is a chronic inflammatory bronchial disease
associated with airway hyperresponsiveness, variable airflow obstruction, and episodes of
wheezing, breath-lessness, and cough; in asthma they have a marked variability in response to
a range of environmental stimuli and life style changing. Many of the asthma symptoms
common in younger patients are present in older patients but aging influences the symptoms
of asthma and the risk of mortality. Management of asthma in the elderly is no different than
in younger populations, except the medications may be less effective and less tolerated. The 5-
step approach of Global Initiative of Asthma (GINA) has been used to achieve asthma control.
Inhaled corticosteroids (ICS) are important controller therapies in patients with persistent
asthma, yet appear to be underutilized in elderly. Older patients should be given an ICS with a
lower bioavailability and at the lowest dose to control their disease, with consideration of step-
down therapy if the patient is well controlled for at least three months. However, ICS use
reduces hospital admissions and mortality in older adults and it is still currently the preferred
medication for older patients with persistent disease.

Keywords: Asthma, Elderly, Corticosteroids