Assessment on admission and responses to treatment were studied in 20 patients aged 65 years or over admitted with severe acute exacerbations of asthma and were compared with patients aged 40 years or less who were managed similarly. The elderly asthmatic had less marked tachycardia and pulsus paradoxus compared to the younger group for similar degrees of airways obstruction and arterial blood gas abnormalities. Assessment confined to physical examination would, therefore, have underestimated the severity of their asthma. The rates of improvement in airflow obstruction were similar in both young and old but those elderly patients who had required maintenance oral corticosteroids were less likely to reach their predicted peak expiratory flow rate (PEFR) than their peers or younger patients.
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