A study in the American Journal of Respiratory and Critical Care Medicine reports that older asthma patients, particularly those treated with inhaled corticosteroids, appear to be at an increased risk for treatment failure compared to those under the age of 30.

Michael E. Wechsler, MD, MMSc, director of the Asthma Program at National Jewish Health in Denver, CO, and colleagues evaluated data on 1,200 patients with mild-to-moderate asthma from 1993–2003. The primary outcome was asthma treatment failure, defined as one of the following: asthma exacerbation requiring oral corticosteroid or emergency room visit; worsening of lung function; increased use of asthma medication; or physician clinical judgment.

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Older patients had a slightly higher median medication adherence average than those aged <30 (92.5 vs. 89.9%, P<0.001). Treatment failures were reported in 17.3% of patients aged ≥30 compared to 10.3% of those aged <30, but these rates did not significantly differ among males and females. Patients aged ≥30 using inhaled corticosteroids alone or in combination with another treatment were more than twice as likely to experience treatment failure compared to those aged <30. Treatment failures in older patients were reported more frequently as an increase in rescue medication use and having more asthma exacerbations in younger patients. The primary predictors of treatment failure in older patients were lower lung function, longer duration of asthma, and earlier onset of asthma.

It is not clear if the decreased responsiveness to asthma therapy with increasing age is due to biological mechanisms such as differences in type of airway inflammation in older patients or demographic variations between younger and older patients.

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