senile asthma
Introduction
Introduction to senile asthma Senile asthma is a chronic airway inflammation involving a variety of cells, particularly mast cells, eosinophils, and T lymphocytes. In susceptible individuals, this inflammation can cause recurrent wheezing, shortness of breath, chest tightness, and/or Cough and other symptoms occur mostly at night and/or in the early hours of the morning, and the airway is more reactive to a variety of stimuli. However, the symptoms can be relieved by themselves or by treatment. basic knowledge The proportion of illness: 0.03% Susceptible people: the elderly Mode of infection: non-infectious Complications: coronary heart disease, cerebral arteriosclerosis, hypertension, diabetes
Cause
Causes of senile asthma
Long-term smoking (30%):
Long-term smoking is one of the important causes of senile asthma in later years. Long-term smoking is known to cause changes in airway hyperresponsiveness (BHR), which is one of the major pathophysiological features of asthma. Lee reported 15 elderly patients with asthma after the age of 60, 11 of whom were smokers or former smokers. It was also reported that the prevalence of asthma in elderly smokers was significantly higher than that in non-smokers. Therefore smoking is considered to be a more important cause of illness. Whether in children or in old age, even passive smoking is one of the important factors that induce asthma. It is generally believed that the physical and chemical damage of the respiratory mucosa caused by long-term smoking and the nerve fiber exposure caused by chronic inflammation can lead to an increase in airway responsiveness, and the lowering of the elasticity of the lung tissue of the elderly and the relative weakness of the respiratory muscle are more likely to occur.
Drug factors (20%):
Older people are susceptible to ischemic heart disease, arrhythmia, hypertension, glaucoma, so use a variety of 2-receptor blockers (such as propranolol, heart, thiophene, metopine, acetophenone, etc.) There are relatively many opportunities, and these drugs can block the 2-receptors of bronchial smooth muscles and make them susceptible to paralysis. Studies have shown that old age and young people are susceptible to 2-receptor blockers, causing or aggravating asthma, while the elderly are significantly more likely to use 2-receptor blockers, and older people are induced by airway contraction. Symptoms are not sensitive, and it is not easy to get timely diagnosis and treatment, which can cause more serious consequences. Long-term use of 2-receptor blockers can also reduce the 2-receptor function in the airway, breaking the original receptor balance of the respiratory tract, and increasing the incidence of asthma. There are also elderly patients with glaucoma who use timolol solution to reduce intraocular pressure. Eye drops, resulting in a fatal asthma attack after absorption. Because many elderly people often take aspirin under the guidance of a doctor to prevent and treat cerebral thrombosis and ischemic heart disease, plus indomethacin in elderly patients with diseases such as degenerative or rheumatoid arthritis There are also many opportunities for non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen. These drugs often induce acute exacerbations of asthma. The mechanism and NSAIDs can inhibit cyclooxygenase in the metabolism of arachidonic acid. Blocking the synthesis of prostaglandins leads to more arachidonic acid metabolism into the lipoxygenase pathway, resulting in a substantial increase in the synthesis of leukotrienes in the body, leading to asthma attacks.
Gastroesophageal reflux (15%):
Older people are prone to gastroesophageal reflux (GER), and gastroesophageal reflux is an important factor in causing or aggravating asthma. It causes bronchoconstriction and spasm through "microspiration" and vagal reflex, leading to asthma. occur. A recent 24-hour pH test in the esophagus showed that about 57% of elderly people with symptoms such as cough and wheezing had gastroesophageal reflux.
Environmental factors (12%):
In the elderly, the water content and cell heat of the cells are relatively small, and the elderly have a significant decrease in temperature and adaptability, and it is more likely to induce asthma when exposed to cold air. Due to the deterioration of systemic function in elderly patients, especially the deterioration of cardiopulmonary function, the tolerance of elderly patients to exercise load is reduced, or the incidence of exercise asthma in elderly asthma patients is higher than that of asthma patients of other age groups.
Reduced resistance (10%):
Decreased systemic and local resistance in the elderly can cause respiratory infections, especially repeated respiratory viral infections can damage airway epithelial cells and cause BHR. A study of 140 patients with asthma over the age of 60 found that 94% were caused by infection-induced asthma. Another report reported that 85% of senile asthma was induced by infection.
Other factors (8%):
The vagal nerve excitability is elevated in elderly patients with asthma, and 14 of the 15 patients with asthma who reported after Lee et al. showed paroxysmal nocturnal dyspnea.
It is generally believed that with the increase of age, the degree of allergic reaction of the body will decrease, such as the degree of allergic reaction to allergens such as dust mites and pollen will be reduced, so the allergic factors in the pathogenesis of childhood asthma are significantly more important than senile asthma. However, allergens are still an important factor in senile asthma. Other factors that can induce airway hyperresponsiveness such as smoke, paint and spices can also induce senile asthma. Certain food additives, preservatives, bleaches, etc. can also be a predisposing factor for senile asthma.
Prevention
Senile asthma prevention
1, vitamin A is good for the prevention and treatment of asthma. Vitamin A is the most abundant in animal foods. Asthma is prevented from liver, egg yolk, butter, butter, etc., but asthma patients can't eat fatty things. People with asthma can't eat more. Some people think that as long as they are good for the body, we all Can be used to make up the body, in fact, this statement is wrong. In general, asthma patients avoid eating (or eating less) foods such as egg yolk, cock, fat pork, lamb, dog meat, sea fish, clams, crab, pepper; saccharin, flavor, color, chocolate; ice cream and so on, soda, etc. Carbonated drinks, wine, coffee, strong tea, etc.
2, the elderly should eat more green leafy vegetables and orange-yellow vegetables in the daily diet, these dishes are rich in carotene, carotene can be converted into vitamin A in the body, so it is said to play a certain role in asthma.
3, eat more foods with high protein content such as eggs, milk, lean meat, chicken, fish, etc., can supplement the protein consumed by asthma, enhance resistance.
4, soybeans and their products are also beneficial for asthma patients such as: soy milk, tofu and so on.
5, medicine porridge can be stomach and spleen, Yifei Runzao. When adding porridge, add lily, sesame, chestnut, autumn pear, chrysanthemum and carrot, etc., so as to treat the disease while supplementing nutrition, so it is a two-pronged method, which can receive the effect of benefiting the lungs, moistening and nourishing the body. .
6, senile asthma should also be strictly prohibited to eat irritating foods, such as: pepper, salty and too sweet things, because too sweet and salty is not suitable for asthma patients, it will make the condition worse.
Complication
Senile asthma complications Complications coronary heart disease cerebral arteriosclerosis hypertension diabetes
Patients with senile asthma have more comorbidities and comorbidities. The most common comorbidities are age-related cardiovascular and cerebrovascular diseases (such as coronary heart disease, cerebral arteriosclerosis, hypertension, etc.) and diabetes. Others include hypertensive hearts. Disease, left heart failure and cardiopulmonary insufficiency, etc., these associated diseases make the diagnosis of asthma more difficult. At the same time, patients with senile asthma are also susceptible to chronic bronchitis, COPD and other respiratory diseases, which are confused with asthma and lead to misdiagnosis. In addition, senile asthma is one of the characteristics of senile asthma due to decreased resistance to senile asthma and decreased immune function, which may be susceptible to a cold or a concurrent respiratory infection.
Symptom
Symptoms of senile asthma common symptoms sputum cough, wheezing, short bronchial smooth muscle spasm, exercise, asthma
Cough, cough, shortness of breath and paroxysmal nocturnal wheezing. In Tucson City's (TUCSON) study of asthma, 70% of senile asthma patients had shortness of breath accompanied by wheezing, while only 11% of non-asthmatic older people had shortness of breath accompanied by wheezing. In 63% of senile asthma patients have decades of cough or decades of cough history before onset. However, due to the insensitivity of the elderly to the lack of timely treatment, the correct diagnosis and timely treatment were delayed. A study by Lee et al found that 14 of 15 patients with senile asthma had cough and paroxysmal nocturnal wheezing with chest tightness and chest tightness.
Due to the functional degeneration of the systemic and respiratory organs of the elderly and the slowing of the nerve conduction velocity in the elderly, the response to the symptoms is slow, and the stimulation threshold of the airway response is also reduced, and the basic lung function reserve is insufficient. It is easy to lead to severe asthma and even respiratory failure and sudden death of asthma. Domestic studies have shown that the incidence of severe asthma in elderly asthma patients is almost 2 to 3 times that of non-elderly patients. Therefore, it is necessary to be vigilant and timely for senile asthma. Diagnosis and active treatment are very important.
Examine
Examination of senile asthma
First, ask the medical history carefully
Including a detailed understanding of smoking history, personal and family allergic disease history, occupational exposure history, especially the history of allergic rhinitis in young age has an important guiding role in the diagnosis of senile asthma. The performance, cause, pattern and regularity of asthma, mitigation, history of cardiovascular disease, sudden dyspnea, paroxysmal wheezing or nocturnal paroxysmal dyspnea are suspected of asthma. In the past history, you should pay attention to the history of cardiovascular disease, the symptoms of digestive system such as acid reflux and hernia.
Second, physical examination
At the same time as the detailed lung examination during physical examination, special attention should be paid to the presence or absence of signs of allergic rhinitis. In addition, attention should be paid to the presence or absence of signs of heart disease, esophageal hiatus and other diseases for differential diagnosis.
Third, pulmonary function test
Pulmonary function test should be used as a routine examination item, especially the following test should be carried out according to the specific conditions of the patient: 1 bronchodilation test: a test method combining treatment and diagnosis, especially suitable for acute exacerbation of senile asthma, For patients with obvious airway obstruction, in addition to inhaling the 2-receptor agonist, prednisone (30 mg/d) may be taken if necessary, and lung function may be reviewed after one week because of the inhalation of bronchodilator. Determining the reversibility of airway obstruction is less valuable in identifying asthma and chronic bronchitis, and the maximum reversible response to airway obstruction after administration is observed one week after the application of adrenal glucocorticoids. 2 Determination of exhalation peak flow rate: This test has the advantages of self-identification, time saving, convenience and easy promotion. For example, the daily variation rate >15% is a powerful basis for the diagnosis of asthma. 3 bronchial provocation test: for elderly patients over 70 years old with FEV1 >70% without obvious obstruction in the airway is still a safe and effective method for diagnosing asthma.
Fourth, cytological examination
Increased number of eosinophils or increased levels of eosinophil cationic protein (ECP) in peripheral blood, sputum or bronchoalveolar lavage fluid contributes to the diagnosis of senile asthma.
V. Serum total IgE and specific IgE levels
Increased serum total IgE levels or specific IgE levels are important for diagnosis, but because the degree of allergic reaction in patients with senile asthma is usually low, there is no significant increase in lgE levels or specific IgE negative still cannot completely deny the diagnosis of senile asthma. Comprehensive analysis should be based on family history of allergies and history of atopic disease.
Diagnosis
Diagnosis and diagnosis of senile asthma
1. A new patient who is diagnosed with asthma at the age of 60 or older.
2. Paroxysmal wheezing or chest tightness, shortness of breath, can not be explained by diseases such as heart disease.
3. The improvement rate of FEV1 or PEF after 2-receptor agonist is 15%.
4. The bronchodilator and glucocorticoid treatment responded well.
5. Excluding chronic bronchitis, obstructive emphysema and other diseases such as ischemic heart disease.
