asthma in older adults

Overview

Asthma is a long-term condition that affects the lungs. It causes the airways to become swollen and narrow, making it harder to breathe. In older adults, asthma can look different from asthma in children, but it is still very manageable with the right care.

Asthma is common in older adults, but it is often underdiagnosed. Many people live with asthma for a long time without knowing it. With proper care, most older adults with asthma are able to stay active and live well.

Asthma can affect people over 65 in two ways: those who have had asthma since younger years, and those who develop asthma for the first time in later life. It can affect anyone, but some people have a higher risk because of other health conditions or lifestyle factors.

Symptoms

Common symptoms

• Wheezing (a whistling sound when you breathe)
• Shortness of breath, especially with activity
• Chest tightness or a feeling of pressure in the chest
• Coughing, especially at night or early in the morning

Symptoms in children

• Coughing that gets worse at night or during exercise
• A wheezing sound when breathing out
• Rapid breathing or using extra muscles to breathe
• Complaining of their chest hurting or feeling heavy

Symptoms in older adults

• Breathlessness during everyday activities like climbing stairs
• Wheezing that comes and goes
• A chronic cough that produces mucus
• Feeling unusually tired or winded after minor effort
• Symptoms that are mistaken for ageing, heart disease, or acid reflux

Causes

Main causes

• Inflammation and swelling inside the airways, which makes them narrow
• Extra production of sticky mucus, which clogs the airways
• Spasms of the air tubes, which briefly narrow the breathing passages further

Risk factors

• Being over 65
• Having a history of asthma or allergies earlier in life
• Smoking or long-term exposure to secondhand smoke
• Other long-term health conditions like acid reflux, chronic lung disease, or heart problems
• Being overweight or having obesity
• Exposure to air pollution, dust, fumes, or strong chemicals
• Having viral lung infections, like the flu or pneumonia

When to see a doctor

See a doctor urgently if:

• If you have new or worsening breathing symptoms, call your doctor or local same-day service the same day.
• If you are using your reliever inhaler more than every 4 hours, or your symptoms keep coming back.
• If you are coughing up blood, or have fever with shortness of breath.

Book a routine appointment if:

• Even if your symptoms are mild, it is worth making an appointment for a breathing assessment.
• If you have been diagnosed with asthma, see your doctor regularly—at least once a year—to review your action plan.
• If your asthma medicines do not seem to be working as well as they used to.

Diagnosis

Asthma in older adults is diagnosed with a careful review of your symptoms, your medical history, and some simple breathing tests. Your doctor will also rule out other conditions that can cause similar symptoms, such as heart failure, chronic obstructive pulmonary disease (COPD), or acid reflux.

Tests that may be done

• Spirometry: you breathe into a machine that measures how much air you can exhale and how fast.
• Peak flow test: you blow into a small device to measure your peak breathing speed, often tracked over a few weeks.
• Fractional exhaled nitric oxide test: you breathe into a device that measures airway inflammation.
• Allergy tests: sometimes blood tests or skin pricks can identify triggers like dust mites or pollen.

What to expect at your appointment

The diagnosis may take a couple of appointments. You will likely be asked about your daily activities, sleep, and any triggers. The tests are simple and painless. After a diagnosis, you and your doctor will create a written asthma action plan that tells you exactly how to manage your condition day to day.

Treatment

Asthma in older adults is treated with a combination of medicines (usually inhaled through inhalers), lifestyle adjustments, and an asthma action plan. The goal is to reduce inflammation, keep airways open, and prevent symptoms so you can stay without limits.

Self-care at home

• Learn how to use your inhaler correctly—your pharmacist or doctor can check your technique.
• Keep a peak flow diary if recommended, and write down your readings.
• Avoid your known asthma triggers, such as cigarette smoke, pet dander, dust, cold air, or strong smells.
• Take your medicines exactly as prescribed, even if you feel well.
• Get a yearly flu vaccine and talk to your doctor about lung-friendly vaccines.

Medical treatments

Treatments usually involve an inhaler or a nebulizer. A preventer inhaler is used to reduce inflammation in the airways over time, and a reliever inhaler is used to quickly open the airways during an attack. Some people may need additional breathing treatments or a combination inhaler. Your doctor will tailor the approach to you. Never stop or change your medication without speaking to your doctor.

When is surgery considered?

Surgery is not a usual treatment for asthma. Very rarely, an operation called bronchial thermoplasty might be considered for certain difficult cases, but this is only decided after full specialist assessment.

Living with this condition

Living with asthma as an older adult means keeping a steady routine. Use your inhalers as prescribed, recognise your early warning signs, and don’t ignore symptoms. It’s also important to keep your regular check-ups, even if you feel fine.

Lifestyle tips

• If you smoke, ask for help to quit – this is one of the best things you can do for your lungs.
• Keep your home dust-free and well ventilated.
• Avoid strong fragrances, cleaning sprays, and other airborne irritants.
• Try to keep a healthy weight, as extra weight can make breathing harder.
• Get enough sleep and reduce stress – stress can make asthma worse.

Diet and exercise

A balanced, healthy diet supports your lungs and immune system. Regular physical activity, like walking, swimming, or gentle cycling, can strengthen the muscles you use for breathing. Always build up gradually and carry your reliever inhaler just in case. If exercise triggers your asthma, talk to your doctor about how to manage this rather than avoiding activity.

Mental health and emotional wellbeing

Living with asthma can cause worry, anxiety, or low mood, especially if symptoms feel out of control. It is completely normal to feel this way. Speak to your doctor about your mental health, and consider joining a support group where you can talk openly with others who understand.

Prevention

Asthma itself cannot always be prevented, but you can prevent asthma attacks and keep symptoms under control by avoiding triggers, taking your medicines correctly, and acting early when symptoms start. Daily management makes a big difference.

Vaccines

Vaccines play an important role in preventing infections that make asthma worse. The flu vaccine, COVID-19 vaccine, and pneumonia vaccine are especially recommended for older adults. Ask your doctor or local health service which ones you are eligible for.

Screening programmes

There is no routine screening test for asthma in older adults. However, if you have any breathing concerns, you can ask your doctor for a simple breathing check. Early detection helps start treatment sooner.

Complications

If left untreated

• More frequent and severe asthma attacks that may require hospital care
• Permanent narrowing and damage to the airways over time
• Increased risk of chest infections like pneumonia
• Lower oxygen levels, which can affect the heart and other organs
• Poor sleep, fatigue, and reduced physical function

Long-term outlook

With the right treatment plan and a few daily habits, most older adults with asthma can stay active, enjoy their daily lives, and manage their condition very well. Asthma is a long-term condition, but it does not have to define your days. There is always help available to help you breathe easier.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.