Senile asthma

　　Viral respiratory tract infections (such as rhinovirus, influenza virus) are common triggers for the onset of senile asthma. Moreover, the decreased systemic and local immune function in the elderly makes them prone to recurrent respiratory tract infections. Recurrent respiratory tract infections can damage the airway epithelium, leading to bronchial hyperreactivity (BHR). Reports indicate that 84.4% of late-onset senile asthma is induced by acute upper respiratory tract infection. There are many elderly patients with cardiovascular diseases, and the opportunity to use beta-blockers such as propranolol, indolol, thiazine, metoprolol, and acetazolamide increases. Long-term use of beta-blockers can reduce the function of beta2 receptors in the airways, blocking the beta2 receptors in the bronchial smooth muscle and triggering or exacerbating asthma. The elderly are more likely to use aspirin to prevent ischemic heart disease and cerebral thrombosis, and the opportunity to use non-steroidal anti-inflammatory drugs such as ibuprofen and indomethacin is also high. These drugs can inhibit the metabolism of arachidonic acid, leading to increased leukotriene synthesis and causing asthma. Therefore, the asthma induction and exacerbation in some elderly patients may be the result of using aspirin or non-steroidal analgesics, and some senile asthma may also be related to sinusitis and polyposis. The spontaneous remission rate of senile asthma is low, while the remission rate of childhood asthma reaches 50%. 57% of the elderly are prone to gastro-esophageal reflux, and minute aspiration can cause vagus nerve reflex-induced bronchospasm and spasm.
　　The pathogenesis of senile asthma, especially whether the airway inflammation is the same as that in young people with asthma, is still lacking in evidence.

　　Elderly asthma attacks may be complicated with pneumothorax, mediastinal emphysema, and atelectasis; those with long-term and repeated attacks may be complicated with respiratory tract infections or chronic bronchitis, bronchiectasis.

　　Coughing, expectoration, shortness of breath, and paroxysmal nocturnal asthma attacks. In the research on asthma in Tucson (TUCSON), it was found that 70% of elderly asthmatic patients have shortness of breath accompanied by wheezing, while only 11% of non-asthmatic elderly people have shortness of breath accompanied by wheezing. In 63% of elderly asthmatic patients, there is a history of coughing for decades before the onset of the disease. However, due to the elderly's insensitivity to it, timely medical consultation was not sought, leading to delayed correct diagnosis and timely treatment. The research by Lee et al. found that 14 out of 15 elderly asthmatic patients had coughing and paroxysmal nocturnal asthma attacks, accompanied by chest tightness and a feeling of chest compression.

　　Due to the degenerative changes in the functions of the elderly's whole body and respiratory system organs, the slowing down of the conduction speed of the elderly's nerves, the delayed response to symptoms, the reduced stimulation threshold of airway reactions, and the insufficient basic lung function reserve, once the disease occurs, it is easy to lead to severe asthma or even respiratory failure and asthma sudden death. Chinese studies have shown that the incidence of severe asthma in elderly asthmatic patients is almost 2 to 3 times that of the non-elderly group. Therefore, it is very important to be vigilant about elderly asthma, timely diagnosis, and active treatment.

　　China is gradually entering an aging society, and the health of the elderly has also received social attention. Now, with the annual decline in air quality, respiratory diseases have become common diseases that the elderly cannot ignore. Due to the chronic nature of these respiratory system diseases, preventing the occurrence of diseases should be the focus of the elderly. The prevention of elderly asthma mainly starts from the following three aspects:
　　1. Pay attention to dietary nutrition
　　The elderly should fully provide the necessary nutrition for the immune system to fight infection. Based on light, easy-to-digest, and palatable food, increase the diversity of food types, especially the intake of high-quality protein. Foods such as milk, eggs, fish, and shrimp contain high-quality protein. Elderly patients should have a moderate combination in their weekly diet, that is, they need to have 250 to 500 milliliters of milk, 50 to 100 grams of eggs, and 1 to 2 fish or shrimp meals per week.
　　2. Participate in appropriate sports
　　The elderly need to enhance their physical fitness and improve their immune defense function. The exercise of elderly patients should be carried out under warm weather conditions, 3 to 5 times a week, for more than 30 minutes each time, mainly light physical activity, avoiding intense and competitive exercise methods. As long as a good opportunity is seized, perseverance, and regular exercise is maintained, the body's immunity will be improved.
　　3. Follow the doctor's advice on medication
　　After asthmatic patients receive regular treatment, they should take medication under the guidance of a doctor, and pay attention to the treatment and medication during the remission period. Only in this way can asthma be controlled, and the gradual worsening of asthma can be reduced, leading to better control of the condition. Moreover, it is recommended that elderly asthmatic patients adopt traditional Chinese medicine treatment, as the elderly have weaker physical conditions and are prone to complications. Traditional Chinese medicine has a slow effect but fewer side effects, making it more suitable for elderly patients to choose.

　　The diagnosis of senile asthma first includes a detailed understanding of the patient's medical history. Understanding the patient's smoking history, personal and family history of allergic disease, occupational exposure history, especially the history of allergic rhinitis in early years, has an important guiding role in the diagnosis of senile asthma. The manifestations, triggers, onset patterns, regularity, relief methods, and whether there is a history of cardiovascular disease should be suspected of asthma. In the past history, attention should be paid to the history of cardiovascular disease, symptoms such as acid regurgitation, belching, and other symptoms of the digestive system.
　　During physical examination, while performing a detailed examination of the lungs, special attention should be paid to the signs of allergic rhinitis. In addition, attention should be paid to the signs of heart disease, hiatus hernia, and other diseases for differential diagnosis. The specific examination items include the following aspects:
　　One, pulmonary function tests
　　Pulmonary function tests should be routine examination items, especially the specific tests should be determined according to the patient's specific situation: ① Bronchodilator test: It is a method integrating treatment and diagnosis, especially suitable for the acute attack period of senile asthma. For patients with obvious airway obstruction, in addition to a single inhalation of β2-adrenergic agonists, prednisone (30mg/d) can be taken continuously if necessary, and the pulmonary function should be re-examined after one week. This is because the method of measuring the reversibility of airway obstruction by a single inhalation of bronchodilators is of little value in distinguishing asthma from chronic bronchitis, while the maximum reversible reaction of airway obstruction after the application of adrenal corticosteroids can only be observed after one week. ② Peak expiratory flow rate measurement: This test has the advantages of self-determination, time-saving, convenience, and easy promotion. If the daily variation rate is >15%, it is a strong basis for the diagnosis of asthma. ③ Bronchial provocation test: It is still a safe and effective method for diagnosing asthma in elderly patients over 70 years old with no obvious airway obstruction and FEV1>70%.
　　Two, cytological examination
　　An increase in the number of eosinophils in peripheral blood, sputum, or bronchoalveolar lavage fluid, or an increase in the level of eosinophil cationic protein (ECP), is helpful for the diagnosis of senile asthma.
　　Three, total serum IgE and specific IgE levels
　　An increase in total serum IgE levels or specific IgE levels is helpful for diagnosis, but due to the relatively low allergic reaction degree of senile asthma patients, there is no significant increase in IgE levels or negative specific IgE cannot completely rule out the diagnosis of senile asthma. A comprehensive analysis should be made according to the family history of hypersensitivity and atopic disease history.
　　Four, diagnostic criteria
　　The main criteria for the diagnosis of senile asthma include:
　　1. Patients over 60 years old with newly diagnosed asthma.
　　2. Paroxysmal wheezing or chest tightness, shortness of breath, which cannot be explained by heart disease or other diseases.
　　3. After applying β2-adrenergic agonists, the improvement rate of FEV1 or PEF is ≥15%.
　　4. Good response to bronchodilators and corticosteroids treatment.
　　5. Exclude other diseases such as chronic bronchitis, obstructive pulmonary emphysema, and ischemic heart disease.

　　Elderly patients should eat some lung-moistening, lung-drying, cough-relieving, and asthma-relieving foods while maintaining a light diet and rich nutrition, which is helpful for the prevention and treatment of asthma. The following are some suitable elderly diets recommended:

　　1. Walnut Kernel

　　Grind 1000 grams of walnut kernel into powder, grind 500 grams of fructus psoraleae into powder, mix with honey to make it like syrup, take one tablespoon with wine in the morning. For those who cannot drink alcohol, take it with warm water and avoid mutton. It is suitable for symptoms such as chronic cough, asthma, constipation, and post-sickness weakness due to lung deficiency.

　　2. Almond Porridge

　　Take 10 grams of almond kernel without skin, grind it into powder, decoct the water and remove the dregs, add 50 grams of glutinous rice and appropriate amount of rock sugar, cook it into porridge, and eat it warm twice a day. It can ventilate the lung, dissolve phlegm, relieve cough and asthma, and is a good medicine for treating cough and asthma.

　　3. Sugar Water White Kernel

　　Take 50 grams of white kernel, dry-fry it, break the shell with a knife, remove the shell and outer layer, wash clean with clear water, and cut into small pieces. Clean the pot, add a bowl of clear water, add the white kernel, boil it on high heat, then simmer on low heat for a while, add 50 grams of sugar, boil it to a rolling boil, add a little sugar osmanthus, and it is ready to eat.

　　4. Honey and Almond Preserves

　　Boil 250 grams of sweet almond kernels for an hour, add 250 grams of walnut kernels, reduce the sauce, add 500 grams of honey when the pot is dry, stir well and boil. Almond is bitter and acrid in nature and warm in taste, can reduce lung qi, ventilate the lung and remove phlegm. This recipe can tonify the kidney and lung, relieve cough and asthma, moisten the lungs, and is effective for chronic cough and asthma due to lung and kidney deficiency. Regular consumption can treat chronic cough and asthma due to lung and kidney deficiency.

　　There are few special treatment reports for elderly asthma, and the basic treatment is the same as that for asthma in other age groups, mainly focusing on anti-inflammatory treatment. However, due to the special pharmacokinetics and pharmacodynamics characteristics of the elderly, the treatment of elderly asthma has its particularity. Currently, inhaled medication is also the main treatment for elderly asthma, especially for chronic asthma patients, including inhaled corticosteroids, β2-receptor agonists, cholinergic receptor blockers, and inflammatory mediators antagonists, etc.; inhalation formulations include powder inhalers, metered-dose inhalers, and oxygen-driven nebulizer inhalation in three types; inhalation methods include direct and indirect methods, and adding space is more suitable for elderly patients.