Asthma often goes underdiagnosed and undertreated in the elderly due to misconceptions that it only presents earlier in life. This case report describes an 82-year-old man who experienced chronic breathlessness and cough that were initially misattributed to bronchitis and possible non-tuberculous infection. Imaging and lab findings revealed bronchial wall thickening, mucous plugging, and signs of Type 2 airway inflammation. After spirometry confirmed severe obstructive lung disease, a provisional asthma diagnosis was made and treated with systemic corticosteroids and inhaled ICS/LABA therapy. The patient showed dramatic clinical and spirometric improvement, supporting the diagnosis of very late-onset asthma.
This case underscores the importance of recognizing atypical asthma presentations in older adults and challenges the rigidity of standard diagnostic criteria like bronchodilator reversibility. In elderly populations, comorbidities and atypical symptom profiles complicate diagnosis and treatment. The patient’s transformation highlights the potential for life-changing outcomes when asthma is correctly diagnosed and treated, even late in life. Clinicians should maintain a high index of suspicion for asthma in the elderly, use spirometry, and consider therapeutic trials when appropriate. A multidisciplinary, individualized approach is essential to navigate diagnostic ambiguity and manage comorbid conditions that may hinder asthma control.
Reference: Siu H, Michaud A, Bardin PG. Very Late Age-Onset Asthma: Mimic of Other Respiratory Diseases and Important Diagnosis Not to Be Missed. Respirol Case Rep. 2025 Mar 17;13(3):e70148. doi: 10.1002/rcr2.70148. PMID: 40099028; PMCID: PMC11913527.
