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Introduction: The prevalence of asthma in the elderly has been increasing due to the aging of the global population. Appropriate treatment for asthma in the elderly is now a major issue, as the disease is often fatal and incurs high medical costs in the elderly population. There have been few recent reports on asthma treatment for the elderly in the real-world clinical settings. Objectives: This study was performed to assess how respiratory physicians manage asthma in elderly patients in clinical settings in Japan. Methods: Respiratory physicians in 16 Japanese hospitals responded to a questionnaire survey on asthma and COPD treatment between December 2014 and February 2015. The analysis was performed using data collected from medical records on 2041 asthma patients. Results: The mean patient age was 61.2 years, and 36.6% of the patients were men. In the breakdown by age, 1018 (49.9%) of the patients were elderly (≥ 65 years). Compared to the non-elderly, the elderly patients had a significantly lower BMI, greater smoking history in pack-years, and poorer pulmonary function. There were no significant differences between the elderly and non-elderly in the prescription rates of common medications such as inhaled corticosteroids, long-acting beta-agonists (LABA) administered via inhaler or transdermal patch, long-acting muscarinic antagonists, or leukotriene receptor antagonists. In contrast, mucoactive drugs (18.7% vs. 12.3%, P P P = 0.02). Conclusions: According to this survey, the prescription rates of mucoactive drugs, macrolides, and transdermal LABA were significantly higher in the elderly than in the non-elderly.