Asthma is a common pulmonary disease in pediatrics caused by various reasons. Asthma is commonly referred to as asthma because it is characterized by recurrent attacks with shortness of breath and difficulty in breathing. It is characterized by recurrent attacks, shortness of breath, roaring in the throat, difficulty in breathing, opening the mouth and lifting the shoulders, and shaking the body and fetching the belly.
There are obvious seasonality in the attack of the disease, and it is easy to attack in winter and spring and when the climate changes suddenly. The age of onset is 1 to 6 years old, and most of them have their first attack within 3 years old. Most children have asthma that can be relieved by treatment or on their own, and some children have asthma that disappears completely during adolescence. Most children who receive proper treatment and care can remain free of attacks for life as they grow older. However, if the treatment is inappropriate and the attacks are repeated for a long time, it will affect the function of the lungs and easily cause deficiency of both lungs and kidneys, making it difficult to relieve the wheezing and even to control or endanger the life of the child.
Etiology and pathogenesis
The causes of pediatric asthma are mainly internal and external. The internal causes are attributed to the deficiency of the lungs, spleen and kidneys, resulting in the retention of phlegm and beverages in the lung orifices, which becomes the long-standing root of asthma. The external causes are due to external evil, exposure to foreign substances and odors, as well as a taste for salty and sour foods. The “Hundred Questions for Infants and Children – 56th Question” points out that there are children who suffer from asthma due to lung qi deficiency caused by frightening and violent contact with the heart, those who suffer from asthma due to congestion of lung qi caused by typhoid fever, those who suffer from asthma due to lung deficiency caused by wind and cough, those who suffer from asthma due to lung qi deficiency caused by eating salty and acidic food, and those who suffer from asthma due to lung and liver qi rebellion caused by eating hot and poisonous food that touches the three jiao.
Asthma is mainly in the lungs, and the key to the disease mechanism is phlegm and phlegm, which is repeatedly triggered by external factors. The normal metabolism of human body water and fluid is the responsibility of the three organs: lung is the source of water, spleen and stomach are the sea of water and grain, and kidney is the master of body water and fluid. If the three organs are dysfunctional, the water metabolism will be abnormal and phlegm will be generated. Children’s lungs are delicate, not solid, external evil offend the lungs, or lung weakness, there is no power to rule the section, water and fluid loss of transmission, condensed liquid for phlegm; children are often deficient in the spleen, the spleen is the main transport of water and grain essence, spleen deficiency does not transport, wet brewing phlegm, stored in the lungs; children are often weak kidney, weak kidney, can not evaporate water, so that water and moisture on the flood of phlegm, the collection of liquid into drink. It is said that the original water of phlegm also originates from the kidney; the moving dampness of phlegm is also dominated by the spleen; the final drink of phlegm is also stored in the lung. Children with asthma often have a family history and certain genetic factors, and their lungs, spleen and kidneys are often malfunctioning, which is the basis for the formation of asthma phlegm.
Asthma attacks are caused by the internal retention of phlegm and drinks and the external triggering of evil spirits. Children feel external evil, mainly the six lusts, and the evil of the six lusts enters the lung meridian, the lung loses publicity and lowering, the lung Qi is unfavorable, which triggers the volatile phlegm. In addition, the appetite for acid, salty and thick flavors, fishy hair, exposure to pollen, lint, paint and other abnormal odors, excessive activity or emotional excitement can stimulate the body, touching the phlegm, blocking the airway, affecting the lung’s ventilatory function, and inducing asthma. As stated in “Evidence and Treatment Huixing Volume 5”, asthma is a long and frequent occurrence of phlegm and asthma because of the congestion of gas inside, the untimely sensation outside, and the phlegm in the diaphragm, which are combined to close the airway and make a sound when fighting, resulting in asthma.
Cold Asthma
This evidence is mostly induced by external wind and cold, and the basic cause is external cold and internal drinking. When children are exposed to wind and cold externally, injured by cold internally, or have Yang deficiency, the cold phlegm is easily induced to congest the lung qi, and the airway is obstructed due to the failure of declaring and descending, then they cough and wheeze, and the phlegm is rare and frothy; the phlegm remains in the lung, and the airway is obstructed by it, so the phlegm and qi fight each other, then they breathe rapidly, and the croup can be heard in the throat; the phlegm is depressed internally, and Yang qi cannot be declassified, so the face is dull and the limbs are not warm.
Heat Asthma
This evidence is mostly due to external wind-heat, which induces phlegm, and the phlegm-heat is knotted together, blocking the airway and causing an attack. Children who have a strong Yang body feel heat, or due to fat and sweet stagnation, heat is generated from within, and phlegm is moved by heat. When phlegm and heat intermingle, the lung becomes congested with phlegm and heat, the lung is not conducive to the purging and lowering of the lung, so the cough is shortness of breath and the coughing sound can be heard in the throat.
External cold and internal heat
External cold is mostly caused by external wind and cold; internal heat is often caused by external evil entering the body and turning heat into phlegm and drink, or by the accumulation of heat in the body, which is induced by external evil. If the external wind-cold is heavy, one may see shortness of breath, roaring in the throat, fear of cold, nasal congestion and runny nose; if the surface cold has not been relieved and the evil has entered the interior and turned into heat, one may see shortness of breath, roaring in the throat, fever, thirst and drinking, coughing of phlegm with thick and yellow color, and constipation.
Lung and kidney deficiency
This evidence is mostly due to congenital deficiency of endowment or prolonged illness, phlegm-drink congestion in the lung has not been eliminated, kidney-yang deficiency has appeared, the positive deficiency of the evil loves, the deficiency is mixed with the real. If the upper lung is strong, the patient will see shortness of breath and chest fullness, and phlegm roaring in the throat; if the lower kidney is deficient, the patient will see wheezing and weakness, especially when moving, and fear of cold extremities.
Lung and spleen qi deficiency
The basic pathogenesis of this disease is deficiency of lung qi and failure to consolidate the body surface, and deficiency of spleen qi and loss of health in transportation and transformation. The lung is responsible for the surface, and if the surface of the lung is not consolidated, there will be excessive sweating and colds; the lung is responsible for the qi of the body, and if the lung is deficient, there will be shortness of breath and a weak cough; the spleen is responsible for transportation and transformation, and if the spleen is deficient in transportation and transformation, there will be loss of appetite and loose stools, and if there is a loss of nourishment, the body will be thin.
Spleen and kidney yang deficiency
This is caused by the deficiency of Yang in the spleen and kidneys, the failure of transportation and transformation, and the lack of power of intake and absorption. Cold phlegm injures the spleen, weakness of the spleen yang, and failure of transportation and transformation, resulting in abdominal distension and poor absorption, and loose stools; cold phlegm injures the kidney, and deficiency of the kidney yang cannot be transported and distributed throughout the body, resulting in pale complexion, cold body and limbs, weakness of the feet, and shortness of breath when moving; failure of the kidney qi to fix, resulting in enuresis or increased nocturia.
Lung and kidney yin deficiency
This evidence is caused by the depletion of lung qi due to prolonged illness, and phlegm-heat consuming the two yin of lung and kidney. Lung is delicate and susceptible to disease, and prolonged disease with phlegm-heat consumes lung yin, and the remaining evil stays, resulting in coughing, shortness of breath, shortness of breath, and dry cough with little phlegm; kidney deficiency is susceptible to loss, and prolonged disease with phlegm-heat consumes kidney yin, resulting in thinness, excessive nocturia, or constipation. Yin deficiency generates internal heat, resulting in flushed face, night sweating, and heat in the heart of the hands and feet.
If the phlegm and drinks are not removed, the weakness of the organs is not restored, and the roots of asthma are long-standing, the touch of the trigger can cause another asthma attack, and the repeated attacks cause the righteousness to be unsupported, and the disease is prolonged and difficult to be cured.
Clinical diagnosis
Diagnostic points
(1) Most of them have history of eczema in infancy, history of allergy, family history of asthma.
(2) History of recurrent attacks. The attacks are mostly related to certain triggering factors, such as sudden changes in climate, exposure to cold and heat, eating or contacting certain allergic substances. The attack is usually preceded by sneezing, nasal congestion, coughing and other aura.
(3) The attack is often sudden, with coughing fits, shortness of breath, shortness of breath, phlegm in the throat, and even inability to lie down, irritability, and blue lips.
(4) Croup can be heard in both lungs on lung auscultation, which is obvious on expiration and prolonged on expiration. If there is secondary infection in bronchial asthma, wet woven grass can be heard.
(5) Blood tests: peripheral blood eosinophils are increased (>300 106/L), and if blood specimens are taken after the patient receives adrenocorticotropic hormone treatment, pseudo-increase of white blood cells may occur.
(6) X-ray examination: hyperinflation of the lungs, increased transparency, and lung texture may be increased; when complicated by bronchopneumonia or pulmonary atelectasis, small patchy shadows distributed along the bronchi are seen.
(7) Pulmonary function measurements: decreased ventilation rate and tidal volume, increased residual air volume. The blood gas analysis shows a decrease in PaO2, and the blood PaCO2 may decrease at the beginning of the disease, and then increase when the disease is severe, and the pH may also decrease at the later stage. In the interictal period, only the residual air volume increases, while other pulmonary functions are normal. Daily testing of peak expiratory flow rate (PEF) and its variability throughout the day is a good indicator of subclinical asthma.
(8) Skin test: Skin test with suspected antigens can help to clarify allergens, and the results of skin prick method are more reliable.
Identification and treatment】
Asthma is divided into exacerbation phase and remission phase, and the main focus is on cold, heat, deficiency and the three organs of lung, spleen and kidney. If coughing and wheezing with yellow sputum, hot body and red face, dry mouth and red tongue are heat asthma; if coughing and wheezing are cold, sputum is clear and thin, and tongue coating is white and smooth, it is cold asthma. In the remission period, asthma has been calmed down, the deficiency of the lungs, spleen and kidneys is the main reason, and the deficiency of the three organs is identified.
Treatment: Treatment of this disease should be administered separately according to the onset and remission periods. During the attack period, we should attack the evil to treat the symptoms, and treat the lung mainly, distinguishing between cold and heat, and treating the mixed cold and heat with the evidence. In the remission period, we should support the root of the disease and regulate the functions of the internal organs of the lungs, spleen and kidneys to eliminate phlegm. In addition to oral medication, nebulized inhalation, compressing, acupuncture and moxibustion therapy, as well as environmental therapy and physical and mental therapy can enhance the therapeutic effect.
Classification of evidence and treatment
(1) Exacerbation period
Cold asthma symptoms: cough and wheezing, croup in the throat, white and thin sputum or froth, cold form and cold limbs, clear nasal discharge, pale face, cold and no sweat, pale red tongue, white slippery coating, floating and slippery pulse.
Identification: The evidence is characterized by coughing and asthma, croup in the throat, white and clear sputum, and cold form and limbs. If the wind and cold are heavy on the surface, there is no sweating, the nose is runny and the pulse is floating and tight; if the phlegm and dampness are obstructed, the face is obscure, the phlegm is white and foamy, and the tongue is light and the fur is white.
Treatment: Warming the lung and dispersing cold, resolving phlegm and relieving asthma.
Remedies: Xiao Qing Long Tang combined with San Zi Yang Yin Tang plus or minus. Commonly used drugs: ephedra and cinnamon branch promote the lung to disperse cold; hossein, dry ginger and half-xia warm the lung and dissolve phlegm; white mustard seed, suzi and lycopodium move qi and dissolve phlegm. White peony with cinnamon branch, has the function of relieving the table and Ying, slowing down and calming asthma; Wu Wei Zi and fine spice together, a sour and a pungent, a collection and a dispersal, together to achieve the power of astringent lung and calm asthma. This evidence does not use Bai Shao and Wu Wei Zi alone, in order to avoid acid convergence and astringent retention of evil.
If the cough is heavy, add aster, dong hua, spineflower to resolve phlegm and stop coughing; if the cough is very strong, add dried sagittaria, dilong to relieve spasm and phlegm and calm asthma; if the Qi is rebellious, add ochre to lower Qi. If the superficial cold is not heavy, we can add and reduce the amount of eucommia and ephedra soup.
(2) Symptoms of thermal asthma: coughing and wheezing, high breath, roaring phlegm in the throat, thick yellow phlegm, fullness in the chest and diaphragm, body heat, red face, dry mouth, red throat, yellow urine, constipated stool, slippery pulse.
Identification: The evidence is characterized by coughing and wheezing, high breath, thick yellow sputum, heat in the body and red throat, and red tongue with yellow coating. The key to the identification of this evidence is the internal prevalence of phlegm and heat, and the sign of external wind-heat, which can be mild or severe. It is not difficult to distinguish this evidence from cold asthma according to the presence or absence of heat symptoms.
Treatment: Clearing the lung and eliminating phlegm, relieving cough and asthma.
Remedy: Combination of Ma Heng Shi Gan Tang and Su Scapular Pill with addition and subtraction. Commonly used drugs: ephedra, gypsum and scutellaria to clear heat in the lung; almonds and Qianhu to promote lung and stop cough; scape seeds, soursop and mulberry bark to relieve lung and calm asthma; eucommia, guajoupi and hedgehog shell to lower qi and resolve phlegm.
In case of shortness of breath, add Dilong to clear heat and antispasmodic, remove phlegm and calm asthma; in case of excessive phlegm, add Bile South Star, Bamboo Lick to expel phlegm and lower qi; in case of severe cough, add Roasted Momordicae and Roasted Winter Flower to promote lung and stop cough; in case of heavy heat, add Gardenia, Tiger Balm and Fishy Herb to clear heat and detoxify; in case of heavy red throat, add Flea Hue, Shan Dou Gen and Pan Lan Gen to detoxify and benefit pharynx; in case of constipation, add Guadua Ren, Citrus Aurantium and Rhubarb to lower rebellious and ventilate internal organs. If the symptoms are not obvious, with wheezing and coughing, phlegm sounding, and yellowish phlegm, we can use Ding Wheezing Soup plus or minus, in which apricot and ginkgo are combined with ephedra, which has good astringent effect on lung and asthma, and is the main medicine.
External cold and internal heat symptoms: shortness of breath, cough with phlegm, sneezing, nasal congestion and clear runny nose, or vicious cold and fever, thick and yellow phlegm, thirst, constipation, yellow urine, red tongue, white fur, smooth or tight pulse.
Evidence: The evidence is characterized by shortness of breath, coughing and phlegm, fever, red tongue with white fur. The main point of identification of this evidence is that there is superficial evidence of wind-cold outside and internal evidence of phlegm-heat inside. If the external cold is heavy, the symptoms include coldness, headache, sneezing, nasal congestion and runny nose, and floating and tight pulse; if the internal heat is heavy, the symptoms include fever, thirst and drinking, thick and yellow sputum, constipated stool, and slippery pulse. This evidence is common in those who have cold asthma first, but the cold in the surface has not been relieved and the evil has entered the heat inside.
Treatment: Clearing the exterior and the interior, relieving asthma and cough.
Remedy: Add and subtract Da Qing Long Tang. Commonly used drugs: ephedra, cinnamon stick and ginger to warm the lung and calm asthma; raw gypsum to clear internal heat; raw licorice to harmonize the middle; white peony and Wu Wei Zi to astringent the lung.
If heat is heavy, add Scutellaria baicalensis and Fritillaria fritillaria to clear lung heat; if coughing and wheezing and roaring are severe, add Radix et Rhizoma eucommiae and Morinda citrifoliae to remove heat from the lung; if sputum is abundant, add Radix et Rhizoma heliotrophicum, Pericarpium citrifoliae and Fritillariae suzonicum to warm the sputum, or use Semen scopariae to remove sputum from the lung.
Asthma is persistent, with shortness of breath, chest fullness, shortness of breath when moving, unpleasant complexion, cough with sputum, phlegm in the throat, cold in the extremities, fatigue and dullness, clear and long urine, pale tongue, thin and greasy coating, weak pulse.
Identification: The evidence is characterized by persistent asthma, wheezing when moving, phlegm in the throat, unpleasant complexion, and weak pulse. In case of heavy phlegm-heat, wheezing with chest fullness, fever and heavy cough; in case of heavy kidney deficiency, the disease is prolonged, with more phlegm, cold in the limbs, fatigue and dullness, and clear and long urine.
Treatment: To remove the lung and tonify the kidney, taking into account both the symptoms and the root cause.
Remedies: For those who are on the upper side, use Su Zi Descending Qi Tang plus or minus. Commonly used drugs: Su Zi, almonds, Qian Hu and Panaxia descend Qi and resolve phlegm; Hou Pu and Chen Pi regulate Qi, dry dampness and resolve phlegm; Cinnamon warms the kidney and resolves Qi to move watery drinks; with Angelica invigorates Blood and regulates the Ying; Aster and Dang Dong Hua warm and moisten phlegm and calm asthma. Ginseng and Wu Wei Zi can also be added to benefit Qi and astringent lung.
For those with lower deficiency, use Du Qi Pill with Sheng Gan Ma Huang Tang to add and reduce. Commonly used drugs: Cornus officinalis, Radix Rehmanniae, Radix Bupleurum to benefit the kidney and cultivate the yuan; Huai Shan Yao, Poria to strengthen the spleen and benefit the qi; Dang Dong Hua, Aster to warm and moisten the phlegm; Han Xia, Hsio Xin, Wu Wei Zi to calm the asthma; Ephedra, Sagittariae to promote the lung to dispel phlegm and calm the asthma, moving the shortness of breath plus Walnut, Amethyst, Chebuli to take in and tonify the kidney; cold in the extremities plus Pieces of Pine, Xian Ling Spleen to move the qi and disperse the cold; sputum is white in color, repeatedly vomiting, plus Bai Guo, Gorgonian to tonify the kidney and strengthen the spleen to resolve phlegm; fever, yellow and sticky sputum. Sputum yellow and sticky add Scutellaria baicalensis, dongguazi, golden buckwheat.
(2) remission period
The symptoms of lung and spleen deficiency include recurrent colds, shortness of breath and sweating, weak cough, white face, lazy speech, thinness and poor appetite, loose stools, pale tongue, thin white fur, and soft pulse.
Identification: The main point of identification is the deficiency of Qi in the lung and spleen. If the lung is deficient in qi, the patient is prone to repeated colds and coughs, often triggered by external evil due to climate change; if the lung is deficient in spleen qi, the patient has a cough with a lot of phlegm, a white face with little color, fatigue and lazy speech, and a thin shape, often triggered by poor diet.
Treatment: Strengthening the spleen and benefiting the qi, tonifying the lung and consolidating the surface.
Remedy: Ginseng and Wu Wei Zi Tang with Yu Ping Feng San plus reduction. Commonly used drugs: Ginseng and Wu Wei Zi tonify Qi and astringent lung; Fu Ling and Atractylodes macrocephala strengthen spleen and tonify Qi; Huang Qi and Fang Feng benefit Qi and fix the surface; Bai Bu and Orange Red resolve phlegm and stop cough.
If sweating is very bad, add calcined keel, calcined oyster to stop sweating; phlegm, add half asia, geranium to dissolve phlegm; grain is not fragrant, add jiao Shenqu, grain buds to eliminate food to help transport; abdominal distension, add moxa, heliotrope shells to regulate qi; loose stools, add Huai yam, fried lentils to strengthen the spleen and resolve dampness.
② Spleen and kidney Yang deficiency symptoms pale face, cold body and limbs, weak feet, shortness of breath and palpitations when moving, abdominal distension and poor circulation, loose stools, pale tongue, thin white fur, weak pulse.
Identification: This evidence is based on the deficiency of Yang energy in the spleen and kidney organs. In case of deficiency of Yang of the spleen and kidneys, abdominal distension, poor appetite, loose stools; in case of deficiency of Yang of the kidneys, pale face, cold body and limbs, weakness of the feet, palpitations when moving. In older children, the manifestations of kidney deficiency such as lumbar soreness and knee weakness, lack of warmth in the extremities, and excessive nocturnal urination are seen.
Treatment: Strengthening the spleen, warming the kidney, and consolidating the nourishing Qi.
Remedy: Jin Kui Kidney Qi Pill plus or minus. Commonly used drugs: Radix et Rhizoma, Cinnamon, Deer horn tablet warms the kidney and tonifies Yang; Cornu Cervi Pantotrichum, Shu Di Huang, Xian Ling Spleen tonify the liver and kidney; Huai Shan Yao and Fu Ling strengthen the spleen; Walnut meat, Wu Wei Zi and Ginkgo astringently consolidate Qi.
If the deficiency of asthma is obvious, add mealybug and Cordyceps sinensis to tonify the kidney and nourish the qi; if the cough is severe, add dong hua and aster to stop the cough and dissolve the phlegm; if the nocturia is high, add puzzle nut, codonopsis and bone marrow to tonify the kidney and fix the regimen.
Yin deficiency of the lungs and kidneys: coughing, flushing, night sweating, shortness of breath, heat in the hands and feet, nocturnal urination, red tongue, flaking moss, and fine pulse.
Identification: Yin deficiency in the lungs and kidneys is the main point of identification of this evidence. It is characterized by coughing, shortness of breath when moving, emaciation, red tongue and flaking moss. In cases of Lung-Yin deficiency, a dry cough with little sputum and shortness of breath is seen; in cases of Kidney-Yin deficiency, a thin form and excessive nocturnal urination are seen. In some children with Yin deficiency, internal heat is seen in the form of flushed face, night sweating and heat in the hands and feet.
Treatment: Nourishing Yin and clearing heat, tonifying the lungs and kidneys.
Remedy: Mai Wei Di Huang Wan plus or minus. Commonly used drugs: Mai Men Dong, Lily moisten lung yin; Wu Wei Zi benefit kidney and astringent lung; Cornu Cervi Pantotrichum, Shu Di Huang, Fructus Lycii, Huai Shan Yao tonify kidney yin; Dan Pi clear heat.
In case of night sweating, add Zhi Mu and Huang Bai to clear heat and astringent sweat; in case of choking and coughing, add Bai Bai Bai and Bei Sha Shen to nourish yin and stop cough; in case of hot flashes, add turtle nail and Artemisia absinthium to clear deficiency heat.
Other treatments
Prepared Chinese medicine
(1) Xiao Qing Long Oral Liquid: 10ml per dose, 2 times a day. Used for cold asthma.
(2) Asthma granules: 10g per dose, 2 times a day, with boiled water. For febrile asthma.
(3) Guilong Cough and Asthma: 2 capsules per dose, 3 times a day. Used for mixed cold and heat with deficiency of kidney qi.
Extracutaneous treatment: 21g of white mustard seeds, 21g of Yanhuo, 12g of Gansui and 12g of Hossein, finely powdered, divided into 3 parts and used 1 part every 10 days. Take 1 part of the powder and thicken it with ginger juice as big as 1 cent coin, put it on Lung Yu, Heart Yu, Diaphragm Yu and Tanzhong points respectively, and remove it for 2-4 hours. If the skin becomes red and small herpes appears locally after the patching, it can be removed earlier. The time of patching is 3 times a year in summer, at the beginning, middle and end of the volt, for 3 years.
Acupuncture therapy during the attack period: take the fixed wheezing, Tiantu, and Neiguan. In case of coughing and phlegm, add Tanzhong and Fenglong.
In remission: take Dazhi, Lung Yu, Foot San Li, Kidney Yu, Guan Yuan and Spleen Yu. Take 3 to 4 points each time, lightly prick and moxibustion, once every other day. Preventive treatment before the good season.
Prevention and care]
1.Prevention
(1) Avoid contact with allergens, such as pollen, application of aspirin and food containing additives; avoid various triggering factors, such as passive smoking, lacquer smell, drinking cold drinks, etc.
(2) Pay attention to the prevention of respiratory tract infections, especially respiratory syncytial virus infection and pediatric asthma are closely related. Actively treat and remove infectious lesions, such as timely treatment of sinusitis, nasal polyps, tonsillitis, dental caries, etc.
(3) Avoid overwork, rain, strenuous exercise and mental and emotional stimulation.
(4) Pay attention to climate change, do a good job to prevent cold and keep warm, and prevent cold when going out in winter.
(5) Prevent the recurrence of asthma with medication, such as positive allergen infusion, sodium cromoglycate, ketotifol, inhaled maintenance glucocorticoids and traditional Chinese medicine.
(6) Enhance physical fitness. During the remission period of asthma, children should be encouraged to participate in appropriate activities, such as children’s gymnastics, walking and literary activities, etc.
(7) Strengthen self-management education, teach prevention and control knowledge to children and their families, mobilize their enthusiasm to fight against the disease, and implement standardized management of asthmatic children.
2.Adjustment of care
(1) The room should have good air circulation, appropriate humidity and sufficient sunlight. It should be kept warm in winter and cool and ventilated in summer.
(2) Diet should be light and nutritious, avoid eating cold, greasy, spicy, sweet and sour food and seafood such as fish and shrimp.
(3) Pay attention to breathing and pulse changes to prevent continuous asthma attacks.
(4) Psychological care is very important during asthma attacks, because asthma is a cardioactive disease and nervous system excitement is related to asthma attacks. It is important to care for and comfort the sick child to reduce psychological stress and fear to increase confidence in overcoming the disease.