At least 2 million US citizens over 65 years of age have asthma as a chronic disease, a number that will rapidly increase as the population ages. We used computer-assisted searches to identify epidemiologic studies specific for this age group published in the commonly available medical literature in English between 1988 and 2008. The prevalence of current asthma in individuals aged over 65 years is high (5.3%). Affected patients appear to perceive symptoms of asthma differently than younger patients, often have comorbid conditions with similar symptoms, and present for medical care later and with more fixed airways obstruction. Approximately 50% of deaths from asthma occur in the elderly, and mortality is increasing (10.5/100,000). We found only one longitudinal epidemiologic study that addressed the natural history of asthma in patients aged over 65 years, and that study used historical controls. Asthma in the elderly is a poorly studied, growing chronic disease that is underdiagnosed and undertreated. Present paradigms for diagnosis require modification.