Bronchial asthma in the elderly

In recent years, the incidence of a disease such as bronchial asthma in the elderly has increased dramatically. This can be related to three main factors. First, allergic reactivity increased. Secondly, in connection with the development of the chemical industry, pollution of the environment and other circumstances, contact with allergens is increasing. Thirdly, chronic respiratory diseases, which create prerequisites for the development of bronchial asthma, are increasing. The age structure of the disease also changed. Currently, elderly and senile people account for 44% of the total number of patients with this disease.

[1], [2], [3], [4], [5], [6]

What causes bronchial asthma in the elderly?

In elderly and senile age, the predominantly infectious-allergic form of the disease is found. Bronchial asthma in the elderly occurs more often as a result of inflammatory diseases of the respiratory system (chronic pneumonia, chronic bronchitis, etc.). From this infectious focus, the body is sensitized by the products of decay of its own tissues, bacteria and toxins. Bronchial asthma in the elderly can begin simultaneously with the inflammatory process in the lungs, more often with bronchitis, bronchiolitis, pneumonia.

How does bronchial asthma manifest in the elderly?

In most cases, bronchial asthma in the elderly has a chronic course and is characterized by a persistent obstructed wheezing and shortness of breath, which is aggravated by physical exertion (due to the development of obstructive pulmonary emphysema). Periodic exacerbations are manifested by the onset of asthma attacks. There is a cough with the separation of a small amount of light, thick, mucous sputum. Infectious and inflammatory processes in respiratory organs (acute respiratory infections, exacerbations of chronic bronchitis) play a dominant role in the onset of attacks of suffocation and exacerbation of the disease.

An attack of bronchial asthma usually begins at night or early in the morning. This is primarily due to the accumulation of a secret in the bronchi during sleep, which irritates the mucosa, receptors and leads to an attack. A certain role in this is played by an increase in the tone of the vagus nerve. In addition to bronchospasm, which is the main functional disorder in asthma at any age, in older and older people its course is complicated by age-related emphysema of the lungs. As a consequence, pulmonary insufficiency is quickly followed by cardiac failure.

Once arose at a young age, it can persist in the elderly. In this case, seizures are characterized by a less acute course. Due to the prescription of the disease, pronounced changes in the lungs (obstructive emphysema, chronic bronchitis, pneumosclerosis) and cardiovascular system (cor pulmonale - pulmonary heart) are observed.

During an acute attack, the patient has wheezing, shortness of breath, cough and cyanosis. The patient sits, leaning forward, leaning on his hands. All the muscles involved in the act of breathing are strained. Unlike people of a young age, during an attack, rapid breathing is observed, due to pronounced hypoxia. With percussion, a boxed sound is detected, a lot of sonorous buzzing, wheezing sounds can be heard, wet rales can be determined. At the beginning of the attack, the cough is dry, often painful. After the end of the attack with a cough, a small amount of viscous mucous sputum is released. The reaction to bronchodilators (for example, theophylline, isadrin) during an attack in people of the older age group is slow, incomplete.

Tones of the heart are deaf, there is a tachycardia. At the height of the attack, acute heart failure may occur due to reflex coronary spasm of the coronary vessels, increased pulmonary artery pressure, reduced myocardial contractility, and in connection with concomitant diseases of the cardiovascular system (hypertension, atherosclerotic cardiosclerosis).

How is bronchial asthma treated in the elderly?

To remove bronchospasm both during an attack and in an interictal period, purines (euphyllin, diaphylline, diprofilpin, etc.) deserve attention, which can be administered not only parenterally, but also in the form of aerosols. The advantage of prescribing these drugs before adrenaline is that their administration is not contraindicated in hypertensive disease, cardiac asthma, coronary heart disease, cerebral artery atherosclerosis. In addition, euphyllin and other drugs from this group improve coronary, renal circulation. All this and causes their wide application in geriatric practice.

Despite the fact that adrenaline usually provides a rapid removal of bronchospasm and, thus, arresting an attack, it is necessary to prescribe it to elderly and old people carefully because of their increased sensitivity to hormonal drugs. To resort to subcutaneous or intramuscular injection of adrenaline is possible only if the attack can not be stopped with any medications. The dose of the drug should not exceed 0.2-0.3 ml of 0.1% solution. In the absence of effect, adrenaline administration can be repeated in the same dose only after 4 hours. The administration of ephedrine provides a less rapid, but longer-lasting effect. It should be noted that ephedrine is contraindicated in prostatic adenoma.

Broncholytic properties are possessed by preparations of isopropylnoradrenaline (isadrin, orciprenaline sulfate, novrinin, etc.).

When used in aerosols of trypsin, chymotrypsin and other means to improve sputum discharge, allergic reactions are possible, mainly related to the absorption of proteolysis products. Before their introduction and during the therapy should be prescribed antihistamines. To improve the patency of bronchi, bronchodilators are used.

Drugs of choice are anticholinergics. When intolerance to adrenomimetics (isadrin, ephedrine), abundant sputum and combined with IHD, which occurs with bradycardia, violation of atrioventricular conduction, cholinolytics (atrovent, troventol, truvent, berodual) are prescribed.

In complex therapy for bronchial asthma include antihistamines (dimedrol, suprastin, diprazine, diazolin, tavegil, etc.).

In some patients, novocaine has a beneficial effect: intravenous 5-10 ml of 0.25-0.5% solution or intramuscularly 5 ml of a 2% solution. To stop the attack with success, one-sided novocaine vagosympathetic blockade can be used. Vishnevsky. Two-sided blockade is not recommended, as it often causes side effects in such patients (cerebral circulation, breathing, etc.).

Ganglia blockers for elderly people are not recommended in connection with the occurrence of an antihypertensive reaction.

If bronchial asthma in elderly people is combined with angina pectoris, inhalation of nitrous oxide (70-75%) with oxygen (25-30%) is indicated with the injection rate of 8-12 l / min.

Along with bronchodilators, the attack should always use cardiovascular drugs, since the attack can quickly remove from the state of relative compensation the cardiovascular system of the elderly person.

Hormonal therapy (cortisone, hydrocortisone and their derivatives) gives a good effect, stopping an acute attack and warning it. However, the introduction of glucocorticosteroids in the elderly and senile age should be in doses 2-3 times smaller than those used for young people. In the treatment it is important to establish a minimally effective dose. Hormonal therapy for longer than 3 weeks is undesirable because of the potential for side effects. The use of glucocorticosteroids does not exclude the simultaneous use of bronchodilators, which, in some cases, can be reduced. Dose of hormonal drugs. With secondary infection, antibiotics along with corticosteroids are shown. When treating even small doses of corticosteroids, elderly people often experience side effects. In this regard, glucocorticosteroids are used only under the following conditions:

1. a severe course not treated by other means;
2. asthmatic state;
3. a sharp deterioration in the patient's condition against intercurrent disease.

Very promising is the introduction of glucocorticosteroids in the form of aerosols, since a lower dose of the drug achieves a clinical effect and thereby reduces the incidence of side effects. Day of arrest of an acute attack hormonal preparations can be administered and intravenously.

A wide application for bronchial asthma found kromolin-sodium (intal). It inhibits the degranulation of the mast cells and slows the release of mediator substances (bradykinin, histamine, and so-called slow reacting substances) that contribute to bronchospasm and inflammation. The drug has a preventive effect before the development of an asthmatic attack. Intal used in inhalations of 0.02 g 4 times a day. After the improvement, the number of inhalations is reduced by selecting a maintenance dose. The effect comes in 2-4 weeks. Treatment should be long.

In case of bronchial asthma, in case of an allergen responsible for the disease, it is necessary to exclude it and, if possible, to conduct a specific desensitization to this substance. Elderly patients are less sensitive to allergens, so correct identification of them is very difficult. In addition, they are polyvalent sensitized.

With the development of heart failure prescribed cardiac glycosides, diuretics.

For very anxious patients, tranquilizers (trioxazine), benzodiazepine derivatives (chlordiazepoxide, diazepam, oxazepam), carbamine esters of propanediol (meprobamate, isoprotane), derivatives of diphenylmethane (aminil, metamizil) can be used.

As expectorant and secretolitic agents, bromhexine, acetylcysteine and physiotherapy are most often used.

The appointment of mustard plasters, hot foot baths brings a certain effect in case of an acute attack. Bronchial asthma in the elderly should also be treated with the help of physiotherapy exercises, respiratory gymnastics. The type and volume of physical exercises are determined individually.