Purpose of review <p>This review examines the multifaceted challenges of managing asthma in elderly patients, focusing on diagnostic hurdles, age-related physiological changes, and comorbidity burdens in an aging global population. Key questions include: How do overlaps with conditions like COPD and heart failure complicate diagnosis? What mechanistic shifts drive exacerbations? And what implications arise for personalized care?</p> Recent findings <p>Elderly asthma emerges as a distinct phenotype with worse obstruction, reduced atopy, elevated neutrophilic inflammation (e.g., higher IL-17, IFN-γ), and steroid resistance, partly due to airway trapping and microvascular changes. Comorbidities like cardiovascular disease and GERD are markedly higher, with exacerbations amplifying risks, especially in women and former smokers.</p> Summary <p>Elderly asthma demands a “geriatric” approach integrating multidisciplinary education and patient-centred strategies to boost adherence. Major takeaways emphasize targeting neutrophilic pathways and mitigating multimorbidity to curb exacerbations. Future research should prioritize inclusive trials to refine therapies, ultimately improving outcomes in this vulnerable and often overlooked group.</p>