How to manage flare-ups of bronchial asthma in old age?

Question

Hello doctor,

I am reaching out regarding my 55-year-old mother, who has been living with asthma for many years. Recently, her symptoms have become much harder to control, and she had to visit the emergency room a few times due to severe flare-ups. Despite her current treatment plan, it seems like her asthma is worsening.

Could you advise on additional treatments or options that might help manage her symptoms more effectively?
Given her age and the severity of her recent flare-ups, would biologics or other advanced therapies be appropriate for her at this stage?

We are eager to find a more sustainable solution for her.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Thank you for using this platform.

As you already described, your mother is suffering from bronchial asthma.

The key to treatment of asthma is the use of inhaled medications. For adequate asthma control, appropriate inhalers in the right dose are to be used with adequate technique and it should be used regularly.

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

1. Complete blood count.

2. Serum total IgE.

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, and obesity.

2. Incorrect inhaler technique or if inhaler is not being used regularly.

3. If incorrect inhaled medicines are being used.

The following advice is to be followed if bronchial asthma is diagnosed:

1. Start regularly using inhalers (MDI Budetrol (200/6), two puffs twice daily with 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.

2. Mac spacer (it is to be attached with an inhaler; technique of its usage can be learned online via you tube videos).

3. Consult a pulmonologist either physically or virtually on a regular basis (at least once monthly).

4. Take vaccinations appropriate for the age if not taken already.

5. Control of comorbid conditions, if any, like allergic rhinitis, since uncontrolled allergic rhinitis and GERD often exacerbate asthma, leading to poor asthma control.

6. Ensure she has a written asthma action plan that outlines how to manage her symptoms and what to do in an emergency. This can help her feel more in control.

7. Avoid Triggers: Identifying and avoiding triggers (like smoke, pollution, pets, or certain foods) can significantly improve her condition.

8. Pulmonary Rehabilitation: Some programs offer education and exercises to improve lung function and overall fitness.

9. Lifestyle Changes: Regular exercise (as tolerated), maintaining a healthy diet, and managing stress can all contribute to better asthma control.

10. Monitoring and Technology: Using a peak flow meter to monitor her lung function can help her detect worsening asthma early. There are also smartphone apps that can help track symptoms and medication use.

11. Emergency Preparedness: Make sure she has an emergency plan in place, including access to emergency medications and knowing when to seek urgent care.

12. Regarding biologics, they are an advanced mode of treatment and are meant only if asthma is uncontrolled despite regularly using inhalers in the correct manner.

Get all the investigations and follow up after one week with investigations. I will then evaluate if her asthma is controlled or not and if she requires further kind of treatment.

Take care to follow up with investigations or earlier if further queries are there.

I hope I have answered your query.

Let me know if I can assist you further.

Thank you.