Asthma in infants and children is not easily detectable

  Asthma is a common disease that seriously endangers human health. Epidemiological data on asthma in children aged 0-14 years in China show that only 20% of children with bronchial asthma are completely asymptomatic by the time they reach adulthood. The reason is that some infant asthma attacks are not frequent and can be easily confused with other respiratory diseases with the same symptoms and signs; some infants can also have wheezing when they have respiratory infections, so they are often misdiagnosed as bronchitis or wheezing bronchopneumonia.  Diagnostic criteria for asthma in infants and toddlers: Asthma in children under 3 years of age. At present, the diagnosis of the disease is based on the “Diagnostic Criteria for Infantile Asthma” developed by the national pediatric asthma experts.  The main diagnostic criteria are as follows: (1) age ≤ 3 years, recurrent asthma ≥ 3 times; (2) a large number of rales in the lungs can be heard with a stethoscope; (3) the child often suffers from personal allergic diseases such as infantile eczema or allergic rhinitis; (4) the child may have a family history of asthma or other allergic diseases in first-degree relatives (parents) or second-degree relatives (mother-in-law, grandfather, grandfather, grandmother); (5) the child may have a family history of asthma or other allergic diseases. (5) In determining the diagnostic criteria for asthma in infants and children, appropriate tests should be performed to exclude other asthma-causing diseases, such as foreign body aspiration. Therefore, doctors often need to have the child undergo an X-ray chest radiograph, and pulmonary function, multiple allergen tests, and immune function tests can also help doctors rule out wheezing diseases that are not asthma in infants and children.  In addition, asthma attacks in infants and young children are basically triggered by colds, which are not controlled in time and gradually develop into asthma with lung infection, which is difficult to distinguish from wheezing pneumonia or bronchitis, and people do not know enough about asthma in infants and young children, resulting in the failure to get a clear diagnosis of asthma in infants and young children in time; sometimes even if the diagnosis is clear, some children cannot receive standard comprehensive treatment because they cannot cooperate or because of parents’ prejudice. Sometimes, even if the diagnosis is clear, some children cannot receive standardized comprehensive treatment because of their inability to cooperate or parental prejudice, resulting in some infant asthma developing into persistent asthma in childhood, with serious damage to lung function, difficult to control symptoms, poor prognosis and even death.  The development of asthma in infants and children has a completely different direction, with some of them gradually reducing the number of attacks to full control after standardized treatment as they grow older; the other part gradually worsens and impairs lung function without receiving regular treatment, affecting their quality of life. At present, there is no reliable method at home and abroad to screen which babies will develop persistent asthma, relying mainly on asking parents whether they have a family history of allergy and whether the baby has the corresponding characteristics, or making some laboratory tests to determine after a comprehensive analysis.  Once diagnosed, infant asthma should be treated aggressively and effectively. Management education must be provided for infant asthma: asthma is a chronic inflammation of the airways, often with acute attacks, and the aim of treatment is to standardize medication to control or reduce attacks, which is also the root of asthma treatment. This requires not only the proper guidance of health care professionals, but also the active cooperation of the parents of the sick child. However, it is common to see many children in clinical practice that when they are in remission or do not have an attack for a period of time, parents mistakenly think that they are cured, or worry about the side effects of medication and stop the medication on their own, resulting in recurrent asthma attacks.  Therefore, it is very important to educate children with asthma and their parents about how to self-manage, adhere to the medication and use it correctly for effective asthma control.  To this end, the following aspects should be taken into account: (1) To strengthen the publicity and education, to popularize the knowledge of asthma among children and their parents through various means such as lectures, videos, knowledge competitions, television, distribution of publicity materials or science books, etc., and to answer various questions raised by parents so that they can have a more comprehensive and correct understanding of asthma as a chronic disease, such as the causes, severity, hazards, prognosis, and the benefits of adherence to treatment. and the benefits of adherence to treatment. To eliminate the parents’ misconceptions about asthma, to eliminate their worries about the side effects of inhaled glucocorticosteroids, to enhance their confidence in treatment, to increase their conscientiousness to visit the doctor frequently and to adhere to long-term treatment, so as to reduce the occurrence of severe asthma, to ensure a normal life, to reduce the burden on society and families, to reduce deaths caused by asthma, and to enable most children with asthma to have a colorful life.  (2) To develop individualized treatment plans, provide the best treatment plan to parents of children, make them aware of various medications, and teach them to control asthma themselves, so that children can receive appropriate emergency treatment during asthma attacks and prevent severe asthma attacks.  Inhalation therapy is a new drug delivery measure, and many children are not used to using it and do not have a good grasp of the inhalation technique, which affects the therapeutic effect. Therefore, during the first visit of the child, we should patiently instruct the child and parents how to use and correct them during the subsequent visits. Many children’s poor efficacy after inhalation is due to incorrect inhalation methods.  (4) Parents should be instructed to manage and monitor their children at home. Asthma attacks are often recurrent, and even if inhalation therapy is adhered to, attacks may still occur under certain circumstances. Therefore, parents should be informed of the causes and aura of asthma attacks, so that they can seek timely medical consultation or strengthen treatment with medication to control the disease, reduce severe asthma attacks and avoid hospitalization. Also pay attention to improving the living and working environment to avoid exposure to allergens or triggers.  (5) Establish a good doctor-patient relationship with parents of children with asthma, respect and sympathize with the children, and maintain frequent contact with parents, which is conducive to effective management of the children and monitoring of the condition, as well as improving their adherence to long-term treatment.  (6) Care of infants and young children with asthma and acute exacerbations should be noted that the airways of infants and young children are narrow and very small changes such as minor obstruction, sputum mucus plug and bronchospasm can easily cause an increase in airway resistance, so the condition should be closely observed. The onset of wheezing in infants and young children is often associated with viral infections, as respiratory viral infections increase airway inflammation, damage the airway epithelium, impaired β2 adrenergic receptor function, and increase airway inflammation and reactivity, so attention should be paid to the isolation of children with respiratory viral infections in the environment at ordinary times, while outdoor activities should be strengthened to enhance physical fitness, and attention should be paid to nutrition and vitamin supplementation.