How to manage uncontrolled asthma in older adults?

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

I am sorry to hear about your dad's struggles with uncontrolled asthma (a chronic lung disease). It can be incredibly frustrating and exhausting. Given that his symptoms have worsened to the point of impacting his daily activities and sleep, there may be underlying issues contributing to his breathing difficulties. Here are some possibilities and treatment options to consider:

While asthma is likely at play, other conditions can mimic or worsen asthma symptoms, especially in older adults. For example:

1. Heart conditions, like heart failure, can cause similar shortness of breath and coughing, especially at night.
2. Reflux (GERD) can also worsen asthma, especially if he is having nighttime coughing.
3. Given his age and symptom changes, it might be worth asking his doctor to explore or rule out these conditions with additional tests, like pulmonary function testing, chest X-rays, or an echocardiogram.

Investigations to be done on newly diagnosed or uncontrolled bronchial asthma:

1. Complete blood count.
2. Serum total IgE (immunoglobulin E).
3. Chest X-ray.
4. Pulmonary function test (spirometry pre- and post-bronchodilator).

Causes for repeated exacerbations include:

1. Presence of comorbid conditions like allergic rhinitis, GERD (gastroesophageal reflux disease), and obesity.
2. Incorrect inhaler technique or if the inhaler is not being used regularly.
3. If incorrect inhaled medicines are being used.
4. Medication adjustment.

If his current inhaler is not helping as much as before, his doctor might consider adding or changing to a combination inhaler.

1. Long-acting inhalers that combine corticosteroids and long-acting bronchodilators (like Budesonide/ Formoterol or Fluticasone/Salmeterol) can offer more sustained control.
2. Start regularly using inhalers (for example, drugs like Budesonide/Formoterol Fumarate Dihydrate (200/6) two puffs twice daily with a spacer, followed by mouthwash). Inhalers are to be used on a daily basis without any break for at least six months. No dose is to be skipped unless advised by a pulmonologist (lung specialist).
3. Start using an inhaler with a spacer or valved holding chamber (VHC) (it is to be attached to an inhaler; the technique of its usage can be learned in online videos).
4. For some people with severe, uncontrolled asthma, biologic therapies (injections like Omalizumab, Mepolizumab, or Dupilumab) have proven effective. These target-specific immune responses are involved in severe asthma, but they are typically reserved for those who have not responded well to standard inhalers (when used regularly).
5. Oral corticosteroids for severe flare-ups: During severe exacerbations, a short course of oral corticosteroids is sometimes necessary to get asthma back under control. However, this would be a short-term solution, as long-term use of oral steroids can have significant side effects.
6. Managing nighttime symptoms: Since nighttime coughing is disturbing his sleep, addressing potential triggers might help.

For example, GERD medications could help if acid reflux is a factor. Elevating the head of his bed slightly can sometimes reduce nighttime symptoms. His doctor may also consider adjusting the timing of his medications to ensure they cover nighttime hours effectively.

1. Pulmonary rehabilitation: Pulmonary rehabilitation combines physical therapy and breathing exercises tailored for those with chronic respiratory issues. These programs, often offered through hospitals or clinics, can help improve stamina, reduce symptoms, and enhance overall quality of life.
2. Lifestyle modifications and support: Sometimes, environmental or lifestyle changes can make a big difference in asthma management, such as reducing dust, allergens, or exposure to smoke. Even managing stress, which can worsen asthma symptoms, is beneficial.

Since his symptoms seem to be affecting his mood, it might help to connect him with support groups or counseling. Many people find it helpful to talk to others who manage chronic respiratory conditions.

1. Consult a pulmonologist physically or virtually regularly (at least once monthly).
2. Take vaccinations appropriate for the age if not taken already.
3. Control of comorbid conditions, if any, like allergic rhinitis, since uncontrolled allergic rhinitis and GERD often exacerbate asthma, leading to poor asthma control.
4. Ensure he has a written asthma action plan that outlines how to manage his symptoms and what to do in an emergency. This can help him feel more in control.

Getting these changes in place could help him regain more control over his symptoms and start enjoying his activities again.

Kindly consult a physician, discuss with them, and start taking the medications with their consent.

I hope this information will help you.

Thank you.