Background/Objectives. Asthma in older individuals is poorly understood. We aimed to characterize the older asthma phenotype and test its association with obstructive sleep apnea (OSA). Design. Cross-sectional. Setting. Pulmonary and Asthma/Allergy clinics. Participants. 659 asthma subjects aged 18–59 years (younger) and 154 aged 60–75 (older). Measurements. Sleep Apnea scale of Sleep Disorders Questionnaire (SA-SDQ), asthma severity step (1–4, severe if step 3 or 4), established OSA diagnosis, continuous positive airway pressure (CPAP) use, and comorbidities. Results. Older versus younger had worse control, as assessed by asthma step, lung function, and inhaled corticosteroid use. Among older subjects, after controlling for known asthma aggravators, OSA diagnosis was the only factor robustly associated with severe asthma: on average, OSA was associated with nearly 7 times greater likelihood of severe asthma in an older individual ( ). This relationship was of greater magnitude than in younger subjects ( ). CPAP use attenuated the likelihood of severe asthma in older subjects by 91% ( ), much more than in the younger asthmatics. Conclusion. Diagnosed OSA increases the risk for worse asthma control in older patients, while CPAP therapy may have greater impact on asthma outcomes. Unrecognized OSA may be a reason for poor asthma control, particularly among older patients. 1. Introduction Asthma is a major health problem in the general population. As many patients develop asthma in childhood or adolescence, large community studies have focused on asthma in early years. While the prevalence is estimated to be 6.5–17% [1] and may be similar to that seen in younger adults, asthma is frequently underrecognized as a geriatric respiratory disorder and often remains undiagnosed [2]. This may be due to the fact that older adults tend to underreport symptoms, have limited subjective awareness, lack perception or attribution to pulmonary pathology [2], or lack access to lung function testing such as spirometry and peak flow [3]. Asthma-associated morbidity and mortality increase with older age [4]. The number of unscheduled ambulatory visits, emergency visits, and hospitalizations is high in elderly asthmatics [5]. Elderly individuals with asthma in comparison to young adults have 14-fold higher asthma-related death rates and are twice as likely to be hospitalized in a given year [6]. Death rates attributable to asthma increase exponentially after age of 65 [7], with women and particularly black women being the most affected [8]. Nonetheless, suboptimal therapeutic
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