Elderly bronchial asthma

　　Viral respiratory infections (such as rhinovirus, influenza virus) are common triggers for the onset of elderly asthma. Elderly individuals with reduced systemic and local immune function are prone to recurrent respiratory infections. Recurrent respiratory infections can damage the airway epithelium, leading to bronchial hyperreactivity (BHR). It has been reported that 84.4% of late-onset elderly asthma is induced by acute upper respiratory tract infection. Elderly patients with cardiovascular diseases are more likely to use beta-blockers such as propranolol, indanlol, thiazine, metoprolol, and acetazolamide, increasing the opportunity for their use. Long-term use of beta-blockers can reduce receptor function and block the beta2 receptors of bronchial smooth muscle, thereby triggering or exacerbating asthma. Elderly patients have more opportunities to use aspirin for the prevention and treatment of ischemic heart disease and cerebrovascular thrombosis. They also have more opportunities to use non-steroidal anti-inflammatory drugs such as ibuprofen and indomethacin. These drugs can inhibit the metabolism of arachidonic acid, increase the synthesis of leukotrienes, and lead to asthma. Therefore, asthma induction and exacerbation in some elderly patients may be the result of the use of aspirin or non-steroidal analgesics; some elderly asthma may also be related to sinusitis and polyposis. The spontaneous remission rate of elderly asthma is relatively low.

　　Elderly bronchial asthma (abbreviated as asthma) is a chronic airway inflammation that can cause varying degrees of reversible airway obstruction symptoms in susceptible individuals. The main complications of elderly bronchial asthma are recurrent respiratory tract infections and pulmonary infections.

　　Typical elderly bronchial asthma has prodromal symptoms such as sneezing, runny nose, cough, chest tightness, etc., before an attack. If not treated in time, asthma may occur due to the aggravation of bronchial obstruction. Severe cases may be forced to sit or assume a sitting posture with breathing, dry cough, or expectoration of a large amount of white frothy sputum, and even cyanosis. However, it can usually be relieved with self-treatment or with asthma medication. Some patients may have a recurrence a few hours after relief, even leading to a persistent asthma state. In addition, atypical asthma may also exist in clinical practice, such as cough variant asthma. Patients may have a cough without obvious cause for more than 2 months, often occurring at night or in the early morning, exacerbated by exercise, cold air, etc. There is a high degree of airway reactivity, and treatment with antibiotics or cough suppressants, expectorants is ineffective. Bronchodilators or corticosteroids are effective, but other diseases causing cough need to be excluded.

　　The prevention of asthma is divided into three levels: primary prevention, aimed at preventing asthma by eliminating risk factors; secondary prevention, which involves early diagnosis and treatment in the absence of symptoms to prevent the progression of asthma; and tertiary prevention, which is to actively control asthma symptoms, prevent the deterioration of the condition, and reduce complications. The prevention of elderly bronchial asthma also follows these principles, and the specific methods to avoid and interventions are as follows:

　　Asthma is a polygenic hereditary disease.
　　The heritability is 70% to 80%, so heredity is an important risk factor, and genetic counseling should be conducted during mate selection. If both parents are susceptible to the disease, the possibility that their children are also susceptible is much higher than if only one parent is susceptible, so it is advisable to avoid choosing susceptible individuals as partners. There is also a certain correlation between blood type and the incidence of asthma. People with type A blood are prone to asthma and allergic rhinitis, while those with type O blood are much less likely to suffer from such diseases.

　　2. Control environmental triggers
　　It is mainly to determine, control, and avoid contact with various allergens, occupational sensitizers, and other non-specific irritant factors. The most common food causing allergy is fish, shrimp and crab, eggs, milk, etc. Occupational sensitizers include toluene diisocyanate, zinc phthalocyanine, ethylenediamine, penicillin, protease, amylase, silk, animal dander or excrement, etc. In addition, there are also formaldehyde, formic acid, and others. In addition, some specific and non-specific inhaled substances can also induce asthma. The former includes dust mites, pollen, fungi, animal hair, etc.; non-specific inhaled substances include sulfuric acid, sulfur dioxide, chlorine, ammonia, etc. Asthma can be induced when the temperature, humidity, atmospheric pressure, and (or) air ions change, so there are more cases in cold seasons or when the seasons change from autumn to winter.

　　3. Psychological factors
　　Emotional excitement, anxiety, anger, and other emotions of patients can promote asthma attacks. It is generally believed that it is caused by reflexes or over-breathing through the cerebral cortex and vagus nerve. Therefore, psychological treatment should be provided for the elderly to strengthen self-management, self-relaxation, and self-adjustment.

　　4. Avoid respiratory tract infections
　　The formation and attacks of asthma are related to repeated respiratory tract infections. In asthma patients, there may be specific IgE to bacteria, viruses, mycoplasma, and others. If the corresponding antigens are inhaled, asthma can be induced. Viral infection can directly damage the respiratory epithelium, causing an increase in respiratory reactivity. Some scholars believe that interferon and IL-1 produced by viral infection can increase the amount of histamine released by basophils. Therefore, in daily life, attention should be paid to keeping indoor air fresh and circulating. Try to avoid public places during susceptible periods. Enhance personal resistance, add clothes in time, and wear a mask in cold seasons.

　　5. Asthma and drugs
　　Some drugs can cause asthma attacks, such as propranolol, which can cause asthma by blocking β-adrenergic receptors. 2.3% to 20% of asthma patients may develop asthma due to the use of aspirin and other drugs, known as aspirin asthma. Patients may have nasal polyps and low tolerance to aspirin, and are therefore also known as aspirin triad. Patients may have cross-reactivity to other antipyretic and analgesic drugs and non-steroidal anti-inflammatory drugs. Elderly people need to take aspirin and β2 receptor blocking drugs for the treatment of cardiovascular and cerebrovascular diseases. To avoid asthma attacks, a weighing of benefits and risks should be made to selectively use medications.

　　6. Smoking
　　About 60% of elderly asthma patients have a history of smoking, and most patients develop asthma after many years of smoking. It is precisely because of the long-term smoking that leads to high airway reactivity that the elderly should avoid smoking and quit as soon as possible.

　　7. Community intervention
　　Encourage patients to establish a partnership with healthcare professionals, objectively evaluate the severity of asthma attacks through regular lung function tests, avoid and control asthma triggers, reduce recurrence, formulate a long-term medication plan for asthma management, develop treatment plans for attack periods, and conduct long-term regular follow-up health care.

　　Pulmonary ventilation function examination is of great value for the diagnosis of elderly asthma. If the peak expiratory flow (PEFR) is continuously measured and the PEFR changes by more than 15% to 20% within 24 hours, or if the PEFR improves by more than 15% after the use of bronchodilator drugs, asthma can be considered as a diagnosis.
　　Laboratory examination:If complications occur, the elderly blood count may be normal or the white blood cell count may increase, and the eosinophil count may increase.
　　Other auxiliary examinations:During asthma attacks, FEV1 decreases and DLCO decreases.

　　Dietary recommendations for elderly bronchial asthma patients:

　　1. Eating more high-protein foods such as eggs, milk, lean meat, chicken, and fish can supplement the protein consumed due to asthma and enhance resistance.

　　2. Vitamin A is beneficial for the prevention and treatment of asthma. Vitamin A is most abundant in animal foods, such as liver, egg yolks, butter, and cream, and if the intake of fats is too high, asthma patients should not eat too much.

　　3. The elderly should eat more green leafy vegetables and orange-yellow vegetables, which are rich in carotenoids, and carotenoids can be converted into vitamin A in the body.

　　4. Soybeans and their products, such as soy milk and tofu, are beneficial to asthma patients.

　　5. Elderly asthmatics should strictly avoid spicy and stimulating foods, and overly sweet or salty foods are also not suitable for asthma patients, as they can worsen the condition.

　　6. Medicinal porridge can harmonize the stomach, strengthen the spleen, benefit the lungs, and moisten the dryness. Adding lily, sesame, chestnuts, autumn pears, chrysanthemum, and carrots to the porridge as 'medicinal and food both', can achieve the effects of benefiting the lungs, moistening the dryness, and strengthening the body.

　　The treatment of this disease has three main goals: ① Maintain normal or approximately normal pulmonary function; ② Prevent asthma attacks and deterioration of the condition; ③ Avoid significant side effects of bronchodilator drugs. To achieve these goals, according to the characteristics of the elderly, the treatment of elderly bronchial asthma should pay attention to the following points.

　　1. Education and management of elderly asthma patients Because asthma is a chronic disease that often recurs, it requires long-term regular treatment and close cooperation from patients. Research shows that due to poor memory, limited economic conditions, and the lack of care from others, the elderly have little understanding of the nature of asthma, the rate of adhering to systematic and regular treatment is low, and changes in the condition often cannot be treated promptly or hospitalized in time.

　　2. Stepwise treatment and pulmonary function monitoring According to the clinical manifestations of the patient and the pulmonary function monitoring indicators, asthma can be divided into mild, moderate, and severe conditions. Currently, countries around the world advocate for selecting different treatment plans according to the severity of asthma acute attacks and adjusting them in real-time according to the changes in the condition, which is known as 'stepwise treatment'. Studies have shown that relying on doctors' or patients' subjective impressions to judge the severity of asthma is inaccurate, and elderly patients often underestimate the condition due to less daily activities. Therefore, it is recommended to promote peak expiratory flow (PEFR) monitoring for moderate to severe asthma. Even in the elderly, after a brief explanation and training, the vast majority can correctly apply peak expiratory flow meters to self-test the PEFR changes before and after morning and evening, and adjust the treatment plan according to the records of PEFR changes.

　　3. The application of asthma drugs Unlike the asthma of many young people, which is only occasionally发作 and only requires short-term treatment, most elderly asthma often requires a longer period of continuous treatment and often requires combined medication to control symptoms. The basic drugs for treating elderly asthma are the same as those for treating asthma at other ages, but these drugs should be fully considered in the characteristics of the elderly when using these drugs.

　　β-adrenergic agonists: Such as salbutamol (Salbutamol, salbutamol), terbutaline (terbutaline, Bolicani, terbutaline), fenoterol (phenylproterenol, fenoterol), clenbuterol (clenbuterol, aminoclenbuterol), salmeterol (Salmeterol, Salmeterol) and others.

　　Theophylline drugs: In China, theophylline drugs are still commonly used in the treatment of asthma. In recent years, to maintain effective and stable blood concentrations, it is recommended to use controlled-release tablets or sustained-release preparations of theophylline. In elderly asthma, intravenous injection should be prohibited, and intravenous infusion of aminophylline should be used with caution.

　　M-cholinergic receptor antagonists: Including ipratropium bromide (isopropyl atropine), oxitrepine (oxitrepine) and others. Inhaled in the form of an aerosol, it can achieve the effect of relaxing bronchospasm and reducing airway secretions.

　　Adrenal cortical hormones: A considerable number of elderly asthma patients need to be supplemented with corticosteroids to control symptoms, but the incidence and severity of side effects of long-term use of corticosteroids are more obvious in the elderly than in young people. Such as osteoporosis, diabetes, hypertension, and cataracts, even if corticosteroids are not used, they are more prone to occur in the elderly, and the use of corticosteroids can worsen and恶化 the disease.

　　Other immunotherapy and desensitization therapies: The efficacy of immunotherapy for elderly asthma is not确切.