Assessment of asthma control in elderly patients using Forced Oscillation Technique, spirometry, and asthma control test in relation to GINA classification

Background Asthma prevalence increases with age, yet assessment in elderly patients is often limited by difficulties in performing reliable spirometry. Alternative, noninvasive methods such as the Forced Oscillation Technique (FOT) and fractional exhaled nitric oxide (FeNO) measurement may improve evaluation of asthma control in this population.Objective To evaluate asthma control and treatment effectiveness in elderly patients using the Asthma Control Test (ACT), GINA classification, spirometry, FOT, and FeNO, and to compare their clinical usefulness.Methods A total of 105 patients aged ≥65 years with diagnosed bronchial asthma were enrolled. All participants completed the ACT and underwent spirometry (FEV1, FVC, FEV1/FVC), FOT (R5, R20, R5–R20, X5, AX), and FeNO measurement according to ATS/ERS recommendations. Treatment intensity was classified by GINA steps (Citation1–5). Nonparametric tests and Spearman’s rank correlation were used for statistical analysis.Results ACT scores correlated significantly with spirometric, oscillometric, and FeNO parameters. Lower ACT scores were associated with reduced FEV1% predicted and increased airway resistance and reactance (R5, AX), as well as higher FeNO levels (all p < 0.001). Patients treated at higher GINA steps (Citation4,Citation5) exhibited poorer asthma control, higher FeNO, and less favorable FOT indices. Reductions in FeNO following treatment intensification were accompanied by improvements in FEV1 and FOT parameters, particularly AX and R5–R20.Conclusions FOT provides a useful, noninvasive assessment of asthma control in elderly patients and complements spirometry. FeNO adds important information on airway inflammation and treatment response. Their combined use may enhance monitoring of asthma control when spirometry is limited.