Differential diagnosis of bronchial asthma in the elderly

Asthma is very common in the elderly, with a prevalence of about 7% to 9%. Since many patients with asthma either currently smoke cigarettes or have in the past, they frequently haved mixed disease with features of both asthma (reversible airflow obstruction) and COPD (fixed airflow obstruction). Since patients with COPD often have a reversible component to their condition, asthma medications may relieve some symptoms and improve the patient's quality of life. The differential diagnosis of asthma in the elderly needs to take into account not just COPD, but also other pulmonary conditions such as upper airway obstruction (UAO), interstitial lung disease (ILD), bronchiectasis, pulmonary embolism (PE), and bronchogenic carcinoma. Asthma also needs to be distinguished from nonpulmonary diseases, particularly cardiovascular and gastrointestinal diseases. Finally, it is essential to differentiate the normal, psychologic, and psychosocial changes that accompany aging processes from abnormal changes that accompany age-associated diseases such as asthma.