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Manifestation of bronchial asthma in elderly patients. Bronchial asthma in the elderly: course features, differential diagnosis, treatment. Bronchial asthma in the elderly - treatment and care


Bronchial asthma(BA) is a chronic persistent inflammatory disease of the respiratory tract, manifested by asthma attacks or status asthmaticus, due to bronchospasm, hypersecretion and edema of the bronchial mucosa.

V last years the incidence of bronchial asthma is increasing all over the world. Persons of the elderly and senile age make up about 45% of all BA patients. This is due to age-related changes in the bronchopulmonary system, as well as an increase in chronic diseases of the respiratory system.

Distinguish allergic, non-allergic, mixed shape bronchial asthma... In the development of asthma in the elderly and old age the leading role is played by bacterial allergens.

In the classification of asthma by severity, four stages are distinguished (if the patient does not take basic drugs, then each of these stages corresponds to one of the severity degrees):

1st stage intermittent asthma;

2nd stage mild persistent asthma;

Stage 3 persistent asthma of moderate severity;

4th stage severe persistent asthma.

Determination of the severity depends on the number of night symptoms per month, week, day, the number of daytime symptoms per week, day, severity of disorders physical activity and sleep, indicators of daily fluctuations in FEV and PSV ( peak expiratory flow when performing the FVC test).

Bronchial asthma in the elderly - a clinical picture.

With intermittent asthma, asthma attacks are short, less often than 1 time per week, are stopped by the use of inhalers or pass without use drugs... Nighttime symptoms are less than 2 times a month, symptoms are absent between exacerbations and lung function is normal. FEV, PSV more than 80% of the due and daily fluctuations in PSV less than 20%.

With mild non-persistent asthma asthma attacks occur once a week or more, exacerbations of the disease can disrupt physical activity and sleep, night symptoms more often 2 times a month, FEV, PSV, more than 80% of the due and daily fluctuations in PSV - 20-30%.

With BA ( Bronchial asthma) moderate asthma attacks can be daily, exacerbations of the disease disrupt performance, physical activity and sleep, night symptoms more often than 1 time a week, FEV, PVS within 80-60% of the due and daily fluctuations of PVS more than 30%, daily intake is required β2-adrenergic agonists short action.

In severe asthma there are constant attacks of suffocation. During the day, frequent exacerbations of the disease, frequent nighttime symptoms, physical activity is significantly limited, FEV, PVS, less than 60% of the due, daily fluctuations in PVS more than 30%.

Bronchial asthma in old age often occurs with mild symptoms. In most patients, the disease from the very beginning has a chronic course and is characterized by constant difficulty in wheezing and shortness of breath, aggravated by physical exertion and during periods of asthma attacks.

This is due to the development of pulmonary emphysema.... There is a cough with no division a large number light, thick, mucous sputum. As the disease progresses, sensitization to environmental allergens ( house or industrial dust, pollen, medicines ). Asthma attacks develop with exacerbation of chronic inflammatory processes in the respiratory organs, they can also be provoked by environmental allergens, endocrine disorders, unfavorable meteorological factors, powerful emotions, physical and emotional stress.

In elderly and old patients, asthma attacks are more likely to worsen at night. This is due to an increase in the tone of the vagus nerve at night and the accumulation of secretions in the bronchi that irritate the mucous membrane during horizontal position the patient.

Reaction to bronchodilators during an attack in older people develops more slowly and is incomplete, often this prompts patients to increase the dose bronchodilator... In the midst of an attack of suffocation, an acute heart failure due to age decline myocardial contractility or the presence of concomitant diseases of the cardiovascular system. In elderly and old patients, asthmatic status is more often noted, which is always combined with cardiovascular insufficiency.

Status asthmaticus is characterized by persistent obstruction of the bronchi due to the accumulation of viscous secreted sputum in them, the development of edema of the mucous membrane and expiratory collapse of small bronchi. Factors provoking the development of an asthmatic condition, may be overusesympathomimetics, sedatives and hypnotics drugs, breaks in treatment glucocorticoids, contact with allergens; hypothermia, physical activity, mental stress.

Bronchial asthma in the elderly - treatment and care.

Successful treatment of an elderly patient requires his sanitary education, mastering the methods of control and prevention of bronchial asthma.

In order for geriatric patients to be able to control the course of the disease, it is necessary to involve them in classes in "schools for patients with bronchial asthma."

Currently for long-term treatment bronchial asthma is used a stepwise approach depending on the severity of the course. The basis of the basic (anti-inflammatory) treatment of asthma make up inhaled glucocorticosteroids (budesonide, beclomethasone dinronion, fluticasone pronionate), non-steroidal anti-inflammatory drugs (sodium cromoglycate, nedocromil), antagonists of leukotriene receptors ( zafirlukasm, montelukast).

Symptomatic agents with a bronchodilatory effect are prescribed:

β2-adrenergic agonists long acting (salmeterol, formoterol), long-acting theophyllines(theopec, theotard).

To stop seizures, appoint β2-adrenergic agonists short-acting ( salbutamol, fenoterol, terbutaline), anticholinergics ( Inratronium bromide), short-acting theophyllines ( aminophylline, aminophylline), systemic corticosteroids ( nrednisolone).

Choice medications depends on the severity of the disease. In the treatment of bronchial asthma in geriatric patients, it is necessary to select drugs with an optimal effect and a lower likelihood of side effects ( mainly inhalation forms), use more widely spacers, nebulizers to optimize drug delivery methods.

With an exacerbation of a chronic inflammatory process in the lungs antibiotic therapy is indicated. In the interictal period, it is necessary to sanitize the ENT organs and teeth. Elderly patients should be especially careful to toilet the oral cavity to prevent complications.

Complications: asthmatic status, respiratory distress, pulmonary emphysema, atelectasis, pneumothorax, acute heart failure, chronic cor pulmonale.

Bronchial asthma in the elderly has become Lately very common. According to statistics, today elderly people make up over 44 percent of the total number of patients suffering from this disease. What are the causes and features of the course of bronchial asthma in representatives of the older age category?

What is bronchial asthma?

Bronchial asthma is a disease that affects the respiratory system with concomitant narrowing of the airways due to permanent inflammation. This pathology is characterized by periodic attacks of suffocation, hypersensitivity to different kind external factors- irritants. V neglected form and with a complex protracted course, bronchial asthma can not only lead to a number of consequences and complications, but even cause lethal outcome... People over the age of sixty are at particular risk.

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Causes of pathology

Asthma in older people occurs primarily as a result of functional changes in the organs of the respiratory system, which is an inevitable companion of the aging process of the body. Violations are manifested in the form of changes in the musculoskeletal frame of the sternum, in addition, a decrease in the degree of the cough reflex, as a result of which the airways lose their ability to cleanse themselves, which leads to the development of bronchial asthma.

In addition, experts identify a number of reasons that contribute to the occurrence of the pathology under consideration in persons of the older age category. These include the following factors:

  1. Inflammatory processes of the respiratory system.
  2. Pneumonia.
  3. Chronic bronchitis.
  4. Disturbances in the work of the cardiovascular system.
  5. Bronchodilator.
  6. Systemic vasculitis.
  7. Chronic obstructive pulmonary disease.
  8. Frequent and prolonged acute respiratory infections.
  9. Long-term and uncontrolled intake of certain medications.

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The main signs of the disease

The following symptoms are characteristic of bronchial asthma:

  1. Difficulty breathing, accompanied by a specific whistling sound.
  2. The development of shortness of breath.
  3. Discomfort and a feeling of heaviness in the area chest.
  4. Choking attacks.
  5. Permanent long-term cough that does not respond to conventional treatment.

In addition to the above common symptoms bronchial asthma in humans old age accompanied by a number of additional, specific signs:

  1. Mostly the disease is allergic or inflammatory.
  2. An increase in the degree of manifestation of symptoms in the case of physical exertion.
  3. Whistling cough.
  4. Allocations light color and a slimy character.
  5. Concomitant development of heart failure.
  6. The onset of pulmonary pathologies.
  7. Hypoxia.
  8. Rapid breathing.
  9. Tachycardia.

It should be emphasized that asthma attacks in an elderly person tend to occur at night or in the morning, immediately after waking up. In this case, the patient in most cases sits, leaning on his hands, leaning the body forward. Respiration and heart rate in to a large extent rising. An attack of bronchial asthma begins with a painful dry cough, and at its final stage, sputum is released.

Bronchial asthma is a serious danger to the elderly. In the absence of a literate and timely treatment the likelihood of developing irreversible consequences is high. Therefore, when signs are detected this disease you should immediately apply for medical advice and undergo the necessary examination.

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What is the danger of pathology?

Bronchial asthma itself is a severe pathology of the respiratory system, and in the case of older patients, the situation is aggravated by the general weakening of the body, its increased vulnerability, in addition, by disturbances in the functioning of the immune system. In this case, the development of the following concomitant diseases is observed:

  1. Acute heart failure.
  2. Pulmonary emphysema.
  3. The development of respiratory failure.
  4. Atelectasis.
  5. The appearance of the so-called pulmonary heart in a chronic form.
  6. Pneumothorax.
  7. Development of status asthmaticus.

Bronchial asthma in old age is severe and difficult to treat. At the same time, there is a rapid deterioration in the general condition of the patient, in addition, the development of numerous complications and frequent relapses.

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Diagnostic methods

The presence of bronchial asthma is detected by a detailed analysis of symptoms, the results of anamnesis and a study of the general clinical picture... However, this is only just First stage... The fact is that the diagnosis of the pathology in question in patients with older age group is a rather difficult process. This is due to the presence of numerous disorders in the functioning of various organs and systems caused by the aging of the body.

It is extremely difficult for older people to pass diagnostic tests spirometry, as well as ikflowmetry. Therefore, in order to avoid medical error, the patient is assigned a number of research procedures. The most common of them are:

  1. Test study of expiratory flow rate and forced expiratory volume.
  2. Cytological analysis of sputum discharge.
  3. General and detailed blood test to detect eosinophilia.
  4. Respiratory X-ray examination.
  5. Bronchoscopy.
  6. Taking allergic samples to determine the nature of the disease
  7. Peak flow study to determine the current state of the bronchi
  8. Radiography.

It should be noted that competent and timely diagnosis will greatly facilitate and accelerate the subsequent treatment process, and will also serve as a prevention of development severe complications and related diseases.

Asthma not so much treated as controlled.

There are two types of asthma: allergic (caused by exposure to an allergen) and non-allergic (caused by stress, physical exercise, illnesses such as the common cold or flu, or exposure to extreme weather conditions, irritants in the air, or certain medications).

  • cough;
  • shortness of breath;
  • tightness in the chest;
  • wheezing (wheezing or squeaking sound in the chest when inhaling and exhaling air).
  • allergens such as pollen, dust mites, cockroaches, mold and animal dander;
  • airborne irritants such as smoke, polluted air, chemical vapors and strong odors;
  • medications such as aspirin and acetaminophen;
  • extreme weather conditions;
  • stress.

Allergies are just one of the factors that can trigger an asthma attack. Not all people with asthma suffer from allergies, and many people with allergies do not suffer from asthma at all.

Some pre-existing medical conditions can cause a number of asthma symptoms or make them worse. These include obesity, sleep apnea, heartburn, severe stress and depression. Your allergist should be aware if you have any of these disorders, so you can come to better approach to control your asthma disease and symptoms. Colds and sinus infections can also make asthma worse.

For effective prevention bronchial asthma allergens should be identified and avoided, causing symptoms, with the help of drug therapy and the development of a plan of action in case of serious attacks. Your allergist may also recommend monitoring your asthma with a peak flow meter. This small, handheld device measures how much air you can expel through your lungs. If airflow is low, your allergist may recommend treatment changes, such as additional behavioral or environmental changes, or another asthma medication.

Since this chronic illness, it is impossible to completely cure it. However, there are devices and medications that can help control asthma, as well as criteria for measuring progress.

Correct asthma treatment

There are many effective medicines for asthma prevention. Most people with asthma need two types of medication: medication quick help and long-term medicines for disease control. Immunotherapy (allergy shots) can also be helpful.

Patients may be reluctant to take medications due to cost or potential side effects... If you have similar problems- talk to your allergist. Your doctor will work with you to find the right medicine, or combination of medicines, to manage your asthma and will adjust the dosage based on your symptoms. The goal is to make you feel better about using least amount medicines.

  • Short-acting inhaled beta2-agonists;
  • Anticholinergics.

Both types of drugs are bronchodilators, which means that they widen the passages to the lungs (bronchi), allowing you to breathe in more air and improve breathing. They also help clear mucus in the lungs, allowing it to move more freely and making coughing easier.

If you have exercise-induced bronchospasm, also known as asthma caused by physical activity, your allergist may recommend using these medications before exercise or other strenuous physical activity.

Medications quick action can relieve asthma symptoms, but they do not control the airway inflammation that causes these symptoms. If you find that you need to take fast-acting medicines to prevent asthma symptoms more than twice a week, or two or more nights a month, then your asthma is out of control.

  • antileukotrienes or leukotriene derivatives;
  • sodium cromolyn and nedocromil;
  • inhaled corticosteroids;
  • long-term inhaled beta2 agonists (always given with another asthma-related drug);
  • methylxanthines;
  • oral corticosteroids;
  • immunomodulators.

These medications are taken daily, even if you have no symptoms. The most effective long-term disease control drugs reduce airway inflammation and help improve asthma control.

Peak flow meter


Peak flow meter- An easy-to-use, small hand-held device that helps control asthma by providing a measurement of how well air is exhaled from the lungs.

After exhaling into the device, you will be able to see the result. The doctor will determine how often to check and how to determine how many drugs should be taken by this indicator.

Peak flow meter readings will often be lower better result(it is determined about 2-3 weeks when asthma is well controlled). Even if the symptoms have not yet appeared, but the results are getting worse, this may indicate that an asthma attack is imminent.

After taking medication, peak flow can be used to determine the effectiveness of treatment.

Corticosteroids and risks

Steroids are powerful drugs that can be dangerous if not used as directed by your doctor. Best available medical research show that when taken as directed, inhaled corticosteroids - a type of steroid - are safe and well tolerated and are one of the most effective drugs for asthma prevention.

Some studies have shown that inhaled corticosteroids can reduce the growth rate of children somewhat, perhaps by 1 centimeter per year. The decrease can be related to both the dose and the duration of the drug use. The effect of drugs on final growth in adults is unknown. Any allergist who prescribes corticosteroids for asthma in a child will recommend the lowest effective dose of these drugs and monitor the child's growth.

Discuss any concerns your child may have with an allergist. Never substitute or stop taking prescribed asthma medications unless advised by your doctor.

Signs of Successful Asthma Control

  • Chronic or problem-causing symptoms (such as coughing and shortness of breath) do not occur or occur more than twice a week;
  • There is practically no need for fast-acting medications or they are needed no more than 2 times a week;
  • The lungs work well;
  • Your activity level remains normal;
  • You get enough sleep and do not wake up due to symptoms more than twice a month;
  • You do not need an ambulance;
  • An asthma attack requiring inhalation or corticosteroids occurs no more than once a year;
  • Peak flow values ​​consistently show 80% of your personal maximum.

These results can be achieved by working with a doctor and avoiding factors that can trigger an exacerbation of asthma. You also need to treat other medical conditions that can interfere with asthma control.

Good control also requires avoiding things that can trigger symptoms or worsening asthma, such as allergens.

Because of this, it may be necessary to limit the time spent outside the home during periods when the air is most polluted or contains a large amount of pollen, and to limit contact with animals.

Asthma caused by allergies can be suppressed by getting the necessary allergy shots.

Immunotherapy

There are two types of immunotherapy available: allergen-specific and sublingual (sublingual) tablets.

  1. Allergen-specific: If your asthma is caused by allergies, you should consider allergen-specific immunotherapy, which is very effective in relieving allergy symptoms, and in some cases can actually cure allergies. Treatment, which can take several years, increases immunity to allergens (pollen, dust mites, pets, mold). It works by introducing small quantities allergen in gradually increasing amounts over time. As this immunotherapy helps the body become less sensitive to the effects of the allergen, it will eventually reduce and even eliminate your allergy symptoms.
  2. Sublingual tablets: This type of immunotherapy was approved by the FDA in 2014. Starting a few months before the allergy season, patients dissolve the pill under their tongue daily. Treatment can last up to three years. These drugs should not be used by patients with severe or uncontrolled asthma... Only a few allergens (some herbs and pollen) can be treated with this method, but this is a promising therapy in the future.

Preventive examinations


For correct control asthma needs to see a doctor every 2-6 weeks for a check-up. When the disease is well controlled, examinations can be done less frequently, once a month or six months.

It is also good to get in the habit of tracking symptoms and diagnostic indicators eg peak flow measurements. Doctors may ask about these and daily activities to assess the status of asthma control.

Visit to an allergist and asthma specialist

An allergist can help you learn more about your asthma and develop a treatment plan that works for you.

  • your asthma symptoms occur every day and often at night, limiting your activities;
  • you have had a life-threatening asthma attack;
  • Your asthma goals have not been met within three to six months, or your doctor thinks your body is not responding to current treatment.
  • your symptoms are unusual or difficult to diagnose;
  • you suffer from severe fever or sinusitis that complicates your asthma or your diagnosis;
  • you need additional tests to find the cause of symptoms;
  • you need additional assistance in treatment and instructions for medications;
  • allergy shots can help you;
  • you need oral corticosteroid therapy or high doses of inhaled corticosteroids;
  • you have taken oral corticosteroids more than twice in one year;
  • you have been hospitalized for asthma;
  • you need help identifying triggers for asthma.

A visit to an asthma specialist is recommended if your child is 4 years of age or younger has asthma symptoms every day, and for three or more nights a month. It is worth paying attention to whether your child suffers from asthma symptoms three or more days a week and one to two nights a month.

Although asthma symptoms can be controlled, there is still no cure for asthma. Preventive treatment should minimize all the difficulties caused by asthma and allow a healthy, active image life.

Asthma medications


Asthma medications are divided into short-acting medications and long-term control medications. The former are a quick remedy for symptoms, while the latter reduce airway inflammation and prevent symptoms.

Medicines can be pills, however, most are powders or aerosols that are taken with an inhaler. The inhaler allows the medicine to quickly enter the lungs through the airways.

Inhaler

Also, medications can be administered using nebulizer providing a large, continuous dose. Nebulizers vaporize the medication in saline, converting it into a steady stream of vapor, which is then inhaled by the patient.

Long term control


Long-term control medications are taken every day to prevent airway inflammation. Inhaled corticosteroids are the most effective remedy long-term control, as they are best at helping against inflammation and edema, and when taken daily, prevent asthma attacks.

Although taken every day, corticosteroids are not addictive. However, they can cause mouth infections - candidiasis oral cavity ... This happens when corticosteroids come in contact with the throat or mouth.

Spacers and valve chambers have been developed to prevent the development of infection. Candidiasis can also be avoided by rinsing your mouth after inhalation.

Doctors may prescribe other long-term asthma control medications. Most of them are taken orally to prevent inflammation and clear the airways.


:
  • Long-acting B2 agonists (together with low-dose inhaled corticosteroids)
  • antileukotriene drugs,
  • cromolyn,
  • undermined,
  • theophylline.

Fast-acting medicines


Rapid-acting medications relieve asthma symptoms after they have started. The most common of these are short-acting inhaled B2 agonists - bronchodilators that quickly relax the muscles in the airways, allowing free breathing.

A fast-acting inhaler should be used at the first sign of symptoms, but no more than twice a week. Most people with asthma always carry their inhaler with them.

Rapid-acting drugs usually do not reduce inflammation and therefore should not be a substitute for long-term control drugs.

Urgent care


If medication does not work during an asthma attack or the peak flow meter reading less than half routine, urgent medical attention may be required. Call ambulance and ask someone for help if you cannot walk on your own due to shortness of breath, or your lips or nails are blue.

The hospital ambulance consists of targeted (pure) oxygen (to relieve hypoxia) and high doses of drugs.

Ambulance personnel will likely inject a cocktail of short-acting B2 agonists, oral or intravenous steroids, other bronchodilators, nonspecific injectable or inhaled B2 agonists, anticholinergic drugs, pain relieving ketamine, and intravenous magnesium sulfate.

Intubation ( snorkel throat) and machine ventilation can be used if the patient is unable to breathe on his own.

Asthma in children

Although rapid-acting medications can help relieve shortness of breath in children, if symptoms persist after age 6, medications will be needed for long-term control.

Like adults, children are prescribed inhalations with corticosteroids, montelucan, or cromolyn. Often, medications are tried for 4-6 weeks and canceled if desired result was not reached.

Inhalation of corticosteroids has the side effect of slowed growth, but this effect is very small and is noticeable only in the first months of use.

Asthma in children - video

Asthma in the elderly


Treatment of asthma in older adults may require additional changes to prevent unintended interactions with other medications. Beta blockers, aspirin, pain relievers, and anti-inflammatories can prevent asthma medications from working properly and worsen symptoms.

Also, older people may have difficulty holding their breath for 10 seconds after inhaling the medication. To help this, spacers have been developed.

Increased risk of developing osteoporosis associated with corticosteroid use is increased in older people with weak bones. To maintain healthy bones, calcium and vitamin D tablets are usually taken along with therapy.

Asthma in pregnant women


To ensure good oxygen flow to the fetus, pregnant women need proper asthma control. Mothers with asthma are more likely to give birth premature baby or a low weight child.

For pregnant women, the risks of an asthma attack far outweigh any possible risks from taking medications for asthma.

Vitamin D may relieve asthma symptoms


Researchers at King's College London have found that vitamin D can reduce asthma symptoms. Katerina Gavrilovich and the research team explained that their find could provide new way treating a deleterious and usually chronic condition.

Asthma patients are now prescribed steroid pills, which can have dangerous side effects. However, there is a type of asthma that is resistant to steroid treatment. Patients with this type of asthma are often prone to severe and life-threatening asthma attacks.

Scientists have found that people with asthma have elevated levels of IL-17A (interleukin-17A). IL-17A is a component of the immune system that protects the body from infection. However, this natural ingredient also exacerbates asthma symptoms. Large amounts of IL-17A can weaken the clinical effect of steroids.

The research team found that patients who took steroids had the most high level IL-17A. They also found that vitamin D markedly lowers the production of IL-17A in cells. Katerina Gavrilovich believes that vitamin D can become a new safe and useful tool complementary treatment asthma.

Unconventional treatments

Sometimes patients try to treat asthma with nontraditional alternative methods however, very few data indicate the effectiveness of such treatment.

There has been research showing that acupuncture, air ionizers, and dust mite control techniques have little or no effect on asthma symptoms.

There is insufficient data on the impact of osteopathic, chiropractic, psychotherapy and respiratory therapy techniques. Homeopathy can slightly reduce the severity of symptoms, however, this has not been proven.

Bronchial asthma in old age

The modern way of life, unfortunately, does not at all contribute to the preservation of health and the prevention of various kinds of diseases, rather the opposite. More and more factors environment call us allergic reaction.

And because of the incessant growth industrial production, air and environmental pollution, we are increasingly forced to deal with allergens. The number of diseases of the respiratory system is increasing, which often result in bronchial asthma.

Bronchial asthma (BA) is an inflammation of the airways, a chronic disease. It is accompanied by attacks of acute oxygen deficiency (suffocation) up to status asthmaticus - a serious, life-threatening complication of the patient arising from a prolonged attack.

The respiratory system of a person with this disease weakens, the airways narrow, not allowing the necessary air flow. The consequence of bronchial asthma can be both multiple complications and death.

Causes of the disease

As a rule, bronchial asthma develops more often in the elderly, as a result of infectious and allergic diseases. According to statistics, about 44% of elderly people suffer from asthma resulting from inflammatory diseases respiratory organs of different nature: from to chronic bronchitis.

From this focus of infection, BA develops, most often simultaneously with other inflammations in the respiratory organs.

The deterioration of the respiratory organs, their aging is an inevitable phenomenon and one of the reasons for the development of bronchial asthma. A weakened body changes the musculoskeletal appearance of the chest, reduces muscle contractility and reflex response.

Airways and lungs, devoid of coughing, cannot self-clean and repair

In addition to inflammatory processes in the respiratory system and aging of the body, one of the important reasons possible development bronchial asthma is also considered to be violations in the human cardiovascular system:, (do not also forget that cardiovascular diseases- one of the most frequent).

Also, the cause of the disease can be the intake of incorrectly prescribed medications.

BA classification

Scientists offer several classifications of bronchial asthma according to various criteria: by the forms of asthma, as well as by the severity. The forms of bronchial asthma are derived based on the underlying causes of the disease.

Allocate following forms BA:

  • Allergic (exogenous);
  • Non-allergic (endogenous);
  • Mixed.

Allergic form

The allergic form of bronchial asthma develops under the influence external causes and factors and is characterized, first of all, increased sensitivity respiratory organs to a wide variety of allergens - these can be pollen, mold, dandruff, and so on.

If the pathogen enters the human body through the air, the immune system receives a signal from the brain and bronchial spasm occurs. An inflammatory process of the respiratory system occurs. The main signs of this form of the disease are considered to be the formation of viscous sputum, runny nose, sneezing, tearing and itching of the eyelids.

Non-allergic form

Non-allergic asthma is more common in older people as a result of infectious diseases.

Symptoms are reduced to increased cough, increased sweating and body temperature, general condition weakness and malaise, attacks of suffocation become more frequent and more severe. Also given form the disease can develop due to smoking or exercise.

Video: Lingering cough and bronchial asthma

Mixed form

The mixed form of the disease combines the symptoms of the first two types of the disease and requires a combination of selected treatment.

Severity

According to the severity, they are distinguished:

  • 1st stage - intermittent asthma;
  • 2nd stage - mild persistent asthma;
  • 3rd stage - persistent asthma of moderate severity;
  • 4th stage - severe persistent asthma.

Determination of the stages of asthma is based on calculating the number of symptoms manifested over a certain period of time, showing the level of physical activity of an elderly person and his sleep disorders.

Treatment

AD treatment and diagnosis should be carried out under strict supervision good specialist: choosing the wrong medications can lead to serious consequences. For example, drugs containing aspirin can cause severe choking.

For a complete and comprehensive examination, it is necessary to pass a test to determine the speed of inhalation-exhalation, check the composition of sputum, donate blood for analysis, undergo X-ray irradiation, undergo tests for an allergic reaction - all this will be helped by a specialist.

Do not neglect the fact that timely diagnosis can save your life.

In addition, do not limit yourself to the instructions of a specialist - in addition to drug treatment, it is necessary to do it. They cleanse respiratory tract removing accumulated bacteria and phlegm, facilitate the respiratory process. You should also not abuse physical activity and in the case of asthma, smoking is contraindicated.

Video: Bronchial asthma

Conclusion

Combining all of the above, we can formulate some practical advice who will assist you in making correct decision... Be attentive to your health.

Despite the fact that in your youth you did not have an allergy to anything, it can develop and entail serious consequences. The body is aging and it is more and more difficult for it to resist the microbes and viruses that surround it.

Respiratory diseases require careful and comprehensive treatment. One disease causes the next. Therefore, it is especially important to seek help from a specialist, undergo examinations if your body bothers you.

This must be done at least once every six months.
In the event of the occurrence and development of bronchial asthma of any form and severity, treatment should not be limited to the prescriptions of the attending physician - there is a huge list of folk remedies that have been trusted for years. However, be careful about the components they contain.

In elderly patients, both the diagnosis of bronchial asthma and the assessment of the severity of its course are difficult due to a large number of concomitant diseases, for example, chronic obstructive bronchitis, pulmonary emphysema, coronary artery disease with signs of left ventricular failure. In addition, the number of β₂-adrenergic receptors in the bronchi decreases with age, therefore, the use of β-adrenergic agonists in the elderly is less effective.

· Occupational bronchial asthma accounts for an average of 2% of all cases of this disease. More than 200 substances are known that are used in production (from highly active low molecular weight compounds, for example isocyanates, to known immunogens such as platinum salts, plant complexes and animal products) that contribute to the occurrence of bronchial asthma. Occupational asthma can be allergic or non-allergic. An important criterion diagnostics consider the absence of symptoms of the disease before the onset of this professional activity, a confirmed link between their appearance in the workplace and their disappearance after leaving the workplace. The diagnosis is confirmed by the results of measuring PSV at work and outside the workplace, specific provocative tests. It is necessary to diagnose occupational asthma as early as possible and to stop contact with the damaging agent.

Seasonal bronchial asthma is usually associated with seasonal allergic rhinitis. In the period between the seasons, when an exacerbation occurs, the manifestations of bronchial asthma may be completely absent.

· Cough variant of bronchial asthma: dry paroxysmal cough is the main and sometimes the only symptom of the disease. It often occurs at night and is usually not accompanied by wheezing.



Asthmatic status

Status asthma (life-threatening exacerbation) is unusual in severity for this patient in therapy with bronchodilators. Status asthmaticus is also understood as a severe exacerbation of bronchial asthma, requiring the provision of medical care in a hospital setting.

The development of status asthmaticus may be facilitated by the inaccessibility of constant medical care, the lack of objective monitoring of the condition, including peak flowmetry, the inability of the patient to self-control, inadequate previous treatment (usually the absence of basic therapy), a severe attack of bronchial asthma, aggravated by concomitant diseases.

Clinically asthmatic status characterized by pronounced expiratory shortness of breath, anxiety up to the fear of death. The patient takes a forced position with the torso tilted forward and emphasis on the arms (shoulders are raised). The muscles of the shoulder girdle, chest and abdominal... The duration of exhalation is sharply lengthened, dry wheezing and droning rales are heard, with progression, breathing becomes weakened up to "dumb lungs" (no breathing sounds on auscultation), which reflects the extreme degree of bronchial obstruction.

Complications

Pneumothorax, pneumomediastium, pulmonary emphysema, respiratory failure, cor pulmonale.

Differential diagnosis

The diagnosis of bronchial asthma should be excluded if, when monitoring the parameters of external respiration, no violations of bronchial patency are found, there are no daily fluctuations in PSV, bronchial hyperactivity and coughing attacks.

In the presence of broncho-obstructive syndrome, differential diagnosis is carried out between the main nosological forms for which this syndrome is characteristic.

When carrying out the differential diagnosis of broncho-obstructive conditions, it must be remembered that bronchospasm and cough can cause certain chemicals, including drugs: NSAIDs (most often acetylsalicylic acid), sulfites (found, for example, in chips, shrimp, dried fruits, beer, wines, as well as in metoclopramide, injectable forms of epinephrine, lidocaine), β-blockers (including eye drops), tartrazine (yellow food coloring), ACE inhibitors. Cough caused by ACE inhibitors, usually dry, poorly controlled by antitussives, β-adrenomimetics and inhaled HA, completely disappears after the withdrawal of ACE inhibitors.

· Bronchospasm can also be triggered by gastroesophageal reflux. Rational treatment the latter is accompanied by the elimination of attacks of expiratory dyspnea.

· Symptoms similar to bronchial asthma occur with dysfunction of the vocal cords ("pseudo-asthma"). In these cases, it is necessary to consult an otolaryngologist and phoniatrist.

If infiltrates are detected on chest X-ray in patients with bronchial asthma, differential diagnosis should be made with typical and atypical infections, allergic bronchopulmonary aspergillosis, pulmonary eosinophilic infiltrates different etiology, allergic granulomatosis in combination with angiitis (Churg-Strauss syndrome).

Treatment

Bronchial asthma is an incurable disease. The main goal of therapy is to maintain a normal quality of life, including physical activity.

Treatment tactics

Treatment goals:

· Achieve and maintain control over disease symptoms.

· Prevention of exacerbation of the disease.

· Maintain lung function as close to normal values ​​as possible.

Maintaining normal level activity, including physical.

· Elimination of side effects of anti-asthma drugs.

· Prevention of the development of irreversible bronchial obstruction.

· Prevention of asthma-related mortality.

Control of bronchial asthma can be achieved in most patients and can be defined as follows:

Minimal severity (ideally absent) chronic symptoms, including nightlife.

· Minimal (infrequent) exacerbations.

· No need for ambulance and emergency care.

· The minimum need (ideally no) in the use of β-agonists (as needed).

· No restrictions on activity, including physical.

· Normal (close to normal) indicators of PSV.

· Minimal severity (or absence) of undesirable effects of drugs.

The management of patients with bronchial asthma includes six main components.

1. Educating patients for the formation of partnerships in the process of their management

2. Assessment and monitoring of the severity of the disease, both by recording symptoms and, if possible, by measuring lung function; for patients with moderate and severe course, daily peak flowmetry is optimal.

3. Elimination of exposure to risk factors.

4. Development of individual plans drug therapy for long-term management of the patient (taking into account the severity of the disease and the availability of anti-asthma drugs).

5. Development of individual plans for relieving exacerbations.

6. Providing regular follow-up monitoring.

Educational programs

The basis of the educational system for patients in pulmonology is the "Schools" of asthma. According to specially developed programs, patients are explained in an accessible form the essence of the disease, methods of preventing seizures (elimination of the effects of triggers, preventive use of drugs). In the course of implementation, it is considered mandatory to teach the patient to independently manage the course of bronchial asthma in different situations, develop a written plan for getting out of a severe attack for him, ensure the availability of access to medical professional, teach how to use a peak flow meter at home and maintain a daily PSV curve, as well as correctly use metered-dose inhalers. Asthma schools are most effective among women, nonsmoking patients and patients with high socioeconomic status.

Drug therapy

For the introduction of drugs, metered-dose inhalers are used, and spraying through a nebulizer. For correct application dosing inhalers, the patient needs certain skills, since otherwise only 10-15% of the aerosol enters the bronchial tree. Correct technique application is as follows.

Remove the cap from the mouthpiece and shake the bolon well.

Exhale fully.

Turn the can upside down.

Place the mouthpiece in front of your mouth wide open.

Start a slow inhalation, at the same time press the inhaler and continue to take a deep breath to the end (the inhalation should not be sharp!).

Hold your breath for at least 10 seconds.

After 1-2 minutes, do a second inhalation (for 1 breath, the inhaler needs to be pressed only 1 time)

When using the system " easy breath"(Used in some dosage forms salbutamol and beclomethasone), the patient should open the mouthpiece cap and take a deep breath. It is not required to press on the can and coordinate the inhalation.

If the patient is unable to comply with the above recommendations, a spacer (a special plastic flask into which an aerosol is sprayed before inhalation) or a spacer with a valve - an aerosol chamber from which the patient inhales the drug - should be used.

The correct technique for using the spacer is as follows.

Remove the cap from the inhaler and shake it, then insert the inhaler into the special opening of the device.

Put the mouthpiece in your mouth.

Press the can to receive the dose of the drug.

Take a slow and deep breath.

Hold your breath for 10 seconds, and then exhale into the mouthpiece.

Inhale again, but do not press on the can.

Move the device away from your mouth.

Wait 30 seconds before taking the next inhalation dose.