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Age and sex are associated with differences in asthma prevalence and morbidity.To determine if age and sex associate with distinct phenotypes and a variable response to therapy in subjects with mild to moderate asthma.We used Asthma Clinical Research Network data to determine the impact of age and sex on phenotypes and treatment failures among subjects participating in 10 trials from 1993 to 2003.A total of 1,200 subjects were identified (median age, 30.4 yr; male, 520 [43.3%]; female, 680 [56.7%]) and analyzed. A higher proportion of subjects greater than or equal to 30 years old experienced treatment failures (17.3% vs. 10.3%; odds ratio [OR], 1.82; confidence interval [CI], 1.30-2.54; P 0.001), and rates increased proportionally with increasing age older than 30 across the cohort (OR per yr, 1.02 [CI, 1.01-1.04]; OR per 5 yr, 1.13 [CI, 1.04-1.22]; P 0.001). Lower lung function and longer duration of asthma were associated with a higher risk of treatment failures. A higher proportion of subjects greater than or equal to 30 years old receiving controller therapy experienced treatment failures. When stratified by specific therapy, treatment failures increased consistently for every year older than age 30 in subjects on inhaled corticosteroids (OR per year, 1.03; CI, 1.01-1.07). Females had a slightly higher FEV1 % predicted (84.5% vs. 81.1%; P 0.001) but similar asthma control measures. There was not a statistically significant difference in treatment failures between females and males (15.2% vs. 11.7%; P = 0.088).Older age is associated with an increased risk of treatment failure, particularly in subjects taking inhaled corticosteroids. There was no significant difference in treatment failures between sexes.

Asthma remains one of the most common diseases worldwide and results in significant societal health care costs and in morbidity and mortality to those afflicted. Despite currently available medications, 5-10% of patients with asthma have severe disease with debilitating symptoms and/or life-threatening exacerbations. Bronchial thermoplasty is a device-based therapy with proven efficacy in this subgroup of patients. Thus far, bronchial thermoplasty has been shown to reduce exacerbations and to improve important measures of asthma control. The purpose of this article is to review the pathophysiology of severe asthma, including the role of airway smooth muscle cells and the procedural aspects of bronchial thermoplasty, and to review the evidence behind this important therapy.

Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related physiologic and immunologic changes that complicate the presentation, diagnosis, and management of asthma in the aged population. Evidence suggests that elderly asthmatics are more likely to be underdiagnosed and undertreated. Additionally, elderly patients with asthma have highest rates of morbidity and mortality from their disease than younger patients. The underlying airway inflammation of asthma in this age group likely differs from younger patients and is felt to be non-type 2 mediated. While elderly patients are underrepresented in clinical trials, subgroup analysis of large clinical trials suggests they may be less likely to respond to traditional asthma therapies (ie, corticosteroids). As the armamentarium of pharmacologic asthma therapies expands, it will be critical to include elderly asthmatics in large clinical trials so that therapy may be better tailored to this at-risk and growing population.

Recent statistics have shown that asthma deaths and hospitalizations are decreasing, but there are unmet challenges in the management of severe asthma in children. Current asthma management is focused on achieving asthma control through an effort to minimize asthma impairment via specifically addressing factors that affect day-to-day symptoms, and minimizing the risk of future asthma-related events, such as asthma exacerbations, disease progression, and adverse effects to medications. New targeted medications have been developed for which therapeutic responses have been correlated with specific biomarkers; for example, sputum or blood eosinophil count with anti-IL-5 therapy and serum periostin with anti-IL-13 therapy. These drugs hold great promise, but will likely be expensive alternatives to traditional asthma therapy. There is a growing need to address the age-specific challenges in the management of subjects with asthma from the young to the very old. In the future, it will be important to develop strategies to prevent the development of asthma and, in children with the disease, to maximize the appropriate use of, and adherence to, the available medications before considering more expensive alternatives. To do this, we will need to standardize and harmonize medical care, while improving communication and setting up systems of collaboration. If executed effectively, this effort should have a marked impact on reducing the prevalence of asthma in the future and the consequent burden of asthma on society.