allergic asthma

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OVERVIEW

由致敏因素引起的一种慢性气道炎症，表现为气道高反应及气流受阻的异质性疾病
表现为反复发作性喘息、气促、胸闷、咳嗽
遗传（特应性体质）和接触变应原是变应性哮喘的主要致病因素
主要采用药物控制症状，进行规范化分级治疗

Definition

Allergic asthma is a group of respiratory disorders in which exposure to allergens (sensitizers) causes reversible airway obstruction, increased bronchial reactivity, and chronic inflammation of the airways.

Morbidity

Atopic asthma is one of the most common types of asthma. Therefore, the pathogenesis of allergic asthma is roughly equivalent to that of asthma.

Disease Distribution

  • The prevalence of asthma is higher in developed countries than in developing countries; it is generally higher in urban than in rural areas.
  • Asthma is more prevalent in people with a family history of asthma, in specific practitioners such as those exposed to dust, and in people with poor health.
    • 有遗传家族史：一般认为儿童患病率高于青壮年，老年人群的患病率有增高的趋势。成人男女患病率大致相同。
    特定职业从业者，如长期接触粉尘等职业暴露的职业人员。
    容易过敏的特应性体质的人。

    Incidence

  • Bronchial asthma is one of the most common chronic diseases in the world. The prevalence of asthma varies from 1% to 18% in different countries.
  • The reported prevalence of bronchial asthma in China ranges from 0.5% to 5.29%. The prevalence varies considerably from region to region, from investigator to investigator and from subject to subject, and shows a rising trend year by year.

    • Prevalence

    According to an epidemiologic study conducted by the China Asthma Alliance in 2013, the overall prevalence of asthma in China is 1.24%.

    Causes

    Causes

    Exposure to allergens (sensitizers) is the main cause of allergic asthma. In addition, host factors also influence the development of the disease.

    Host factors

    遗传
  • Allergic asthma has a polygenic genetic predisposition, and its onset runs in families.
  • The closer the relationship, the higher the prevalence.
    • 过敏性疾病史

    History of allergic diseases, such as allergic rhinitis, allergy to certain foods or drugs.

    Allergens

    食入性变应原
  • Shrimp, milk and eggs are the main ones.
  • Others include fish, crab and seafood and medications.
    • 吸入性变应原
  • Dust mites, pet dander and pollen are the main inhalant allergens.
  • Insects, plant fibers, and fungi are secondary allergens.
  • Others include bacteria, dust, fumes, sensitizing or irritating gases and dust.
    • 接触性变应原
  • Daily cosmetics.
  • Topical creams and topical medications.

    • Pathogenesis

    The pathogenesis of allergic asthma is still not fully understood, and it is generally recognized that IgE-mediated allergic airway inflammation is the pathophysiologic basis of allergic asthma.

  • Airway inflammation: reactive allergens enter the sensitized organism, which can induce an inflammatory response in local tissues dominated by eosinophilic infiltration.
  • Airway hyperresponsiveness
    • 气道炎症可继发气道高反应性，并通过释放细胞因子而导致支气管平滑肌收缩、黏膜水肿、腺体分泌功能亢进。
    进而造成分泌物阻塞气道，导致黏膜结缔组织、腺体及上皮层的增生与肥厚（气道重塑）等。
    最终导致气流通过气管受阻，诱发变应性哮喘。

    Symptoms

    Primary Symptoms.

  • May occur within minutes, last for hours to days, and resolve with treatment or on their own.
  • Mostly associated with exposure to allergens, cold air, physical and chemical stimuli, as well as viral upper respiratory tract infections, and exercise.
    • 典型症状

    It is usually sudden, with symptoms appearing within minutes of exposure to the allergen. Symptoms may resolve on their own after removal of the allergen, or after treatment.

  • Wheezing, i.e. increased respiratory rate, may be accompanied by a murmur.
  • Shortness of breath, i.e., rapid, uneven breathing.
  • Dyspnea, i.e., self-consciousness of not being able to breathe.
  • Paroxysmal cough.
  • In severe cases, breathing may be accompanied by a sound similar to whistling.

    • Complications

  • The development of bronchial asthma that causes another disease or symptom to develop is called a complication.
  • If not treated promptly and regularly, bronchial asthma can cause the complications listed below.

    • Infections

  • Chronic infections can develop after repeated episodes of poorly controlled bronchial asthma.
  • The patient may have fever, chills, chills and weakness; in severe cases, cold extremities, excessive sweating, bruising of the skin, lips and mouth, coma and other symptoms may occur.

    • Bronchial dilatation

  • Long-term poor control of bronchial asthma and repeated infections can lead to the destruction of the supporting structure of the airway wall, causing persistent dilatation of the bronchial wall.
  • Patients show symptoms such as repeated coughing, hemoptysis, coughing up a large amount of pus sputum, lack of appetite, and emaciation.

    • Chronic obstructive pulmonary disease

  • If the bronchial airflow obstruction is not controlled for a long time, it will lead to increasing lung volume, destruction of alveolar structure, increasing pulmonary vascular resistance, producing pulmonary hypertension and causing chronic obstructive pulmonary disease.
  • Chronic coughing, coughing up white mucus or plasma foamy sputum, shortness of breath or dyspnea, and in severe cases, wheezing and chest tightness may occur.

    • Thoracic deformity

  • Patients with bronchial asthma, especially those with onset or recurrent attacks at a young age, can be induced to have abnormal thoracic morphology.
  • Patients are prone to serious illnesses such as respiratory infections, which manifest as fever and other infectious symptoms due to varying degrees of compression of the chest.

    • Atretic Lung Syndrome

  • Asthma patients use too much medication, too often, especially β₂ receptor blockers, can make the bronchial spasm increase, resulting in the lungs showing “atresia”.
  • The patient may experience a sudden increase in breathlessness, sitting breathing, severe cyanosis (cyanosis of the skin and lips due to severe oxygen deprivation), nervousness, agitation, sweating, and in severe cases, slowed or even stopped breathing.

    • Consultation

    Department of Medicine

    Respiratory Medicine

    If the cough does not subside for a long time, it is recommended to consult a doctor promptly.

    Pediatrics

    When a child develops a prolonged cough that does not go away, it is advisable to consult a doctor promptly.

    Preparation

    Preparing for your visit: registering, preparing your documents, and common problems.

    Tips

  • Avoid taking cough suppressants on your own before going to the doctor to avoid influencing the doctor’s judgment of the condition.
  • Chest X-rays or chest CT are often needed, so avoid wearing clothes made of metal, and inform the doctor if you are pregnant or planning to become pregnant.

    • Preparation Checklist

    症状清单

    Pay particular attention to the time of onset of symptoms, special manifestations, etc.

  • Is there fever? What is the highest degree?
  • Is there a cough? How long has the cough lasted?
  • Is there any sputum? What kind of phlegm?
  • Is there nasal congestion and runny nose? What is the color and nature of the nasal discharge, such as white, clear water?
  • How long have the symptoms been present?
  • Under what circumstances do the symptoms worsen or lessen?
    • 病史清单
  • Have you had a cold, or been overworked recently?
  • Does anyone in the family have asthma?
  • Are there allergies to certain foods, medications, mites, pollen, etc.?
    • 检查清单

    Test results in the last 6 months to bring to the doctor

  • Laboratory tests: blood test, C-reactive protein, specific IgE test, induced sputum cytology
  • Imaging tests: chest X-ray, chest CT scan
  • Pulmonary function tests: pulmonary ventilation function test, bronchial provocation test, peak expiratory flow rate (PEF) and its variability measurement, bronchodilator test
    • 用药清单

    Medication use in the last 3 months, if there is a box or package of medication, you can bring it with you to the doctor’s office

  • Anti-inflammatory drugs: budesonide aerosol, methylprednisolone, montelukast, zalustat
  • Bronchodilators: salbutamol, terbutaline, aminophylline, ipratropium bromide
  • Cough suppressants: codeine, dextromethorphan

    • Diagnosis

    Diagnosis is based on

    Medical history

  • If your doctor suspects bronchial asthma, he or she will first ask for a medical history.
  • Relevant history may assist the doctor in making a diagnosis if the following are present.
    • 有个人或家族过敏疾病史。如局部皮肤湿疹、过敏性鼻炎、某些食物或药物过敏等。
    有环境致敏原暴露史，如接触油漆、尘螨、真菌、春季花粉、秋季草粉、寒冷空气等。
    有职业性致敏物接触史。如接触谷物粉末、动物皮毛等。
    进食含致敏原的食物，如虾、蟹、牛奶、鸡蛋及小麦等。
    有污染环境暴露史，如接触煤气、油烟、被动吸烟、杀虫喷雾剂等。

    Clinical manifestations

  • Symptoms: sudden onset of wheezing, shortness of breath, paroxysmal coughing and dyspnea.
  • Physical signs
    • 发作时典型体征为两肺对称的以呼气相为主的散在或广泛哮鸣音。
    轻度发作可无哮鸣音。
    严重发作时可出现呼吸音低下，哮鸣音消失。

    Laboratory tests

    血液检查
  • Routine blood tests
    • 血常规检查可测定血液中嗜酸性粒细胞的浓度，辅助医生判断是否处于过敏状态。
    如果血常规检查显示嗜酸性粒细胞过高，一般可确认为变应性哮喘。
    血常规检查前无须禁食禁水，但需要注意不能饮酒。
  • Serum immunologic tests
    • 血清免疫学检测主要为血清特异性IgE检测，属于变应原的体外试验。
    血清免疫学检测可明确患者的过敏状态，指导患者尽量避免接触变应原及进行特异性免疫治疗。
    如果血清出现特异性IgE阳性反应，则可判断患者为变应性哮喘。
    检查前无须禁食禁水。
  • Arterial blood gas analysis
    • 通过动脉血气分析，可对哮喘急性发作的严重程度进行判断。
    重度哮喘发作时，氧分压明显下降而二氧化碳分压超过正常，出现呼吸性酸中毒和（或）代谢性酸中毒。
    动脉血气分析检查前无须禁食禁水，抽（桡）动脉血后需要按压针眼处5～10分钟。
    痰液检查
  • Basic Tests
    • 痰液基本检查可测定痰液中嗜酸性粒细胞的浓度，进而辅助医生判断是否处于过敏状态。
    如果痰液检查显示嗜酸性粒细胞过高，则可判断为变应性哮喘。
    建议留取清晨第一口痰，起床后首先用清水漱口，然后用力将气管内深部的痰液咳出，将其全部放于洁净干燥的容器内，尽快将标本送至医院。
  • Induction Tests
    • 主要为诱导痰液中细胞因子和炎性介质含量的测定。
    主要用于变应性哮喘的诊断和病情严重度的判断。
    注意事项同基本检查。

    Lung Function Tests

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  • Pulmonary function tests play a key role in the diagnosis of asthma, in grading the severity of the disease, and in evaluating the effectiveness of treatment.
    • 哮喘发作时呈阻塞性通气功能障碍表现，用力肺活量（FVC）正常或下降。
    1秒用力呼气容积（FEV1）、FEV1占预计值百分率（FEV1％）、1秒率（FEV1/FVC％）、最大呼气中期流速（MMFR）及最高呼气流量（PEF）均下降。
    以FEV1/FVC％＜70％或FEV1％＜80％为判断气流受限最重要指标及程度。
  • Ventilation Function Tests
    • 用以测定气道反应性。常用吸入激发剂为乙酰甲胆碱和组胺，如FEV1下降≥20％，判断结果为阳性，提示存在气道高反应性。
    适用于非哮喘发作期、FEV1在正常预计值70％以上患者的检查。
  • Bronchial provocation test
    • 用以测定气道的可逆性。
    常用的吸入型支气管舒张剂有沙丁胺醇、特布他林。
    舒张试验阳性诊断标准： FEV1较用药前增加12％或以上，且其绝对值增加200毫升或以上；PEF较治疗前增加60升/分，或增加≥20％。
  • Bronchodilator test
    • 若昼夜PEF波动率≥20％，提示存在气道可逆性的改变。
    检查有助于哮喘的诊断和病情评估。

    Peak expiratory flow rate (PEF) and its variability measurement

  • Imaging
    • 目的：可通过胸部X线检查观察肺部病变，进而辅助医生判断是否患有支气管哮喘。
    意义：如果出现两肺透亮度增加，呈过度充气等表现，可帮助医生诊断。
    注意事项：
    检查前需要出去胸前的金属物品，如项链等。
    胸部X线检查需要保持静止状态一段时间，儿童检查时，需要家长等成人辅助。
  • Chest X-ray
    • 目的：可通过CT检查观察到支气管的相关病变，进而辅助医生判断是否患有支气管哮喘。
    意义：支气管壁如果出现增厚、黏液阻塞等特征性表现，可帮助医生诊断。
    注意事项：
    检查前一般无须空腹，因此，可以正常饮食。
    检查前需要出去胸前的金属物品，如项链等。
    小儿或者危重患者，需要陪同人员。

    CT scan

  • Allergen skin prick test
  • Purpose: The allergen skin prick test is used to guide patients to avoid exposure to allergens and to administer specific immunotherapy.
  • Significance: A positive allergen skin prick test proves that the patient is allergic to the allergen.

    • Cautions: The allergen skin prick test needs to be performed in a hospital with resuscitation facilities.

    Diagnostic Criteria

  • Typical signs and symptoms
  • Sudden onset of wheezing, shortness of breath, paroxysmal cough and dyspnea, often associated with exposure to allergens and cold air.
  • Scattered or diffuse rales can be heard in both lungs during the attack, and the expiratory phase is prolonged.

    • The above signs and symptoms may resolve with treatment or spontaneously.

  • Objective tests for variable airflow limitation
  • Positive bronchodilator test.
  • Positive bronchial provocation test.

    • Mean daily PEF diurnal variation >10% or weekly PEF variation >20%.

    The diagnosis of allergic asthma can be made if the above signs and symptoms are present, along with any of the objective tests for airflow limitation, and if wheezing, shortness of breath, chest tightness, and coughing caused by other diseases are excluded.

    Differential diagnosis

    Left heart failure (cardiogenic asthma)

    Similarities: Both can present with similar symptoms such as wheezing.

    Differences: Patients with left heart failure have a history and signs of hypertension, coronary atherosclerotic heart disease, and mitral stenosis of rheumatic heart disease; heart enlargement and signs of pulmonary stasis can be seen on chest X-ray. Therefore, differential diagnosis can be made by history taking and chest X-ray.

    Chronic obstructive pulmonary disease

    Similarities: Both may present with symptoms such as shortness of breath and wheezing.

    Differences: Patients with COPD often have a history of long-term smoking or exposure to harmful gases; and negative pulmonary function tests and bronchial provocation test or diastolic test can help to differentiate the two.

    Upper airway obstruction

    Similarities: Both may present with symptoms such as dyspnea.

    Differences: Upper airway obstruction can be seen in central bronchopulmonary cancer, tracheobronchial tuberculosis, recurrent polychondritis, and other airway diseases, or foreign body tracheal aspiration, and manifests as progressive inspiratory dyspnea, which can be distinguished from the sudden expiratory dyspnea of allergic asthma. Therefore, differential diagnosis can be made by history taking and symptoms.

    Pulmonary Aspergillosis

    Similarities: Both may present with recurrent episodes of wheezing.

    Differences: Pulmonary aspergillosis is often characterized by low-grade fever, accompanied by cough and mucopurulent sputum; tests suggest positive IgG antibodies to Aspergillus antigens, and total serum IgE is significantly elevated. In contrast, allergic asthma is usually not accompanied by mucopurulent sputum, and IgG is usually negative. Therefore, a differential diagnosis can be made by the nature of the sputum, and serum immunologic tests.

    Pulmonary embolism

    Similarities: Both may present with sudden onset of dyspnea and other symptoms.

    Differences: Pulmonary embolism is often associated with a history of surgery and prolonged bed rest; blood gas analysis reveals marked hypoxemia; however, rales are usually not heard in the lungs and asthma medications are ineffective. In contrast, allergic asthma is usually not associated with a history of surgery and prolonged bed rest, and asthma medications may improve symptoms.

    Diffuse interstitial fibrosis

    Similarities: Both may present with dyspnea.

    Differences: The prominent symptom of diffuse interstitial fibrosis is progressive dyspnea, but the symptoms are generally not seasonal and its episodic nature is not prominent.

    Hyperventilation syndrome

    Similarities: Both can present with deep or fast breathing and dyspnea.

    Differences: Functional tests of internal organs in patients with hyperventilation syndrome are usually normal, and allergen tests are usually negative; there is no rales in the lungs; neither acetylmethacholine nor histamine inhalation can induce it.

    Pleural effusion

    Similarities: both may present with chest tightness, shortness of breath, and breath-holding.

    Differences: Patients with pleural effusion caused by tuberculous pleurisy and other infections usually have fever and chest pain, which are quickly relieved by drainage of the effusion, while asthma medications are ineffective.

    Spontaneous pneumothorax

    Similarities: both can present with dyspnea.

    Differences: Pneumothorax is characterized by a feeling of heavy pressure on the chest, mostly unilateral, inspiratory dyspnea, and ineffective treatment with asthma medications. Lung compression is seen on chest X-ray.

    Treatment

  • Aims and principles of treatment
  • Therapeutic aims: to achieve overall control of allergic asthma, both to achieve current symptom control and to reduce risk factors for poor prognosis.

    • Principles of treatment: The main focus is on general treatment combined with drug therapy, which is effective in most patients. Immunotherapy and other methods of treatment can also be tried according to the condition.

    Treatment Methods

    确定并减少与危险因素接触
  • General treatment
  • Avoid or minimize exposure to various possible allergens, including dust mites, pollen, paint, tobacco, etc.
  • Avoid allergenic drugs and foods.
    • 避免诱发因素
  • Pay attention to prevent cold and keep warm.
  • Pay attention to rest, avoid excessive exercise to induce bronchial smooth muscle spasm.

    • Reasonable adjustment of emotions, avoid nervousness and agitation.

    舒张支气管药物
  • Medication
    • 药物作用：β2受体激动剂可舒张气道平滑肌、降低微血管的通透性、增加气道上皮纤毛的摆动等缓解哮喘的症状。
    常用药物：沙丁胺醇、特布他林、沙美特罗、福莫特罗、丙卡特罗、班布特罗等。
    不良反应：常见不良反应有骨骼肌震颤、低钾血症、心律失常等。短效β2受体激动剂是缓解轻中度急性哮喘症状的首选药物。
    注意事项：长期、单一应用β2受体激动剂可造成细胞膜β2受体的向下调节，表现为临床耐药现象，故应予避免。
  • β2 agonists
    • 药物作用：茶碱类药物可直接作用于支气管平滑肌，具有松弛支气管平滑肌的作用。
    适应证：适用于轻中度哮喘急性发作的治疗，控（缓）释型可用于慢性哮喘的长期控制。
    常用药物：多索茶碱、二羟丙茶碱（喘定）、氨茶碱。
    不良反应：不良反应主要有心律失常、血压下降等。
    注意事项：茶碱使用期间建议监测其血药浓度，避免不良反应。
  • Theophylline
    • 药物作用：通过降低迷走神经张力而舒张支气管，与β2受体激动剂联合应用具有协同、互补作用。
    常用药物：异丙托溴铵和噻托溴铵。
    不良反应：主要有口干、苦味感，偶见干咳和喉部不适。
    注意事项：雾化吸入时，避免药物进入眼内；青光眼、前列腺增生患者慎用。
    抗炎药物
  • Anticholinergic drugs
    • 药物作用：糖皮质激素是最有效的抗变态反应性炎症的药物，可有效缓解支气管哮喘症状。
    常用药物：泼尼松、泼尼松龙或甲基泼尼松龙、琥珀酸氢化可的松、丙酸倍氯米松、布地奈德、丙酸氟替卡松等。
    不良反应：长期口服糖皮质激素可能会引起骨质疏松症、高血压、糖尿病、下丘脑-垂体-肾上腺轴的抑制、肥胖症、白内障、青光眼、皮肤菲薄导致皮纹和瘀斑、肌无力等。
    注意事项：伴有结核病、寄生虫感染、骨质疏松、青光眼、糖尿病、严重忧郁或消化性溃疡的哮喘患者，给予全身糖皮质激素治疗时应慎重，并应密切随访。
  • Glucocorticoids
    • 药物作用：具有较强的抗炎作用，可减轻症状、改善肺功能、减少哮喘的恶化。
    适应证：尤其适用于阿司匹林哮喘、运动性哮喘和伴有过敏性鼻炎哮喘患者的治疗。
    常用药物：扎鲁司特、孟鲁司特等。
    注意事项：一般较少单独使用。因为其抗炎作用不如糖皮质激素，需要与糖皮质激素联合应用。
  • Leukotriene modulators
    • 药物作用：肥大细胞膜稳定剂可阻滞钙离子进入肥大细胞内，减少酶促反应进而阻止肥大细胞脱颗粒，最终预防过敏反应。
    常用药物：色甘酸钠、曲尼司特和托普斯特等。
    不良反应：较少，偶尔可见干咳和排尿困难。
    注意事项：色甘酸钠需要吸入给药，不可口服。
  • Mast cell membrane stabilizers
    • 药物作用：具有抗过敏作用，但在支气管哮喘治疗中作用较弱。
    适应证：可用于伴有变应性鼻炎的哮喘患者的治疗。
    常用药物：酮替芬、氯雷他定、阿司咪唑、曲尼斯特等。
    不良反应：头晕、嗜睡、低血压、心律失常、胃肠道反应等。
    生物制剂
  • Antihistamines
  • Indications: For patients with severe allergic, refractory bronchial asthma that remains uncontrolled on inhaled glucocorticosteroids combined with long-acting β2 agonists.
  • Commonly used drugs: Omalizumab monoclonal antibody, etc.

    • Progress in drug development: further new biological agents such as anti-IL-13 antibody, anti-IL-4Rα antibody, anti-IL-8 antibody, CXCR agonist, p38MAPK inhibitor, etc. targeting different phenotypes are under clinical research.

  • Immunotherapy
  • Indications: Specific immunotherapy is suitable for patients with asthma caused by clear allergens and unsatisfactory conventional treatment, or patients with recurrent attacks due to the inability to avoid exposure to allergens despite the effectiveness of conventional treatment.
  • Domestic progress: at present, the most commonly used specific immunotherapy in China is immunotherapy against dust mite allergy.

    • Treatment: non-specific immunotherapy, such as injection of BCG and its derivatives, transfer factor, vaccine and so on.

  • Traditional Chinese Medicine (TCM)
  • Therapeutic positioning: Bronchial asthma can be treated with the aid of Chinese medicine methods, but it cannot be completely cured.
  • Theoretical basis: Based on the identification of evidence, most of the treatments are based on benefiting the qi and supporting the correctness, dispelling wind and relieving the symptoms, tonifying the kidney, filling the essence and activating the blood, and so on.
  • Treatment method: adopt Chinese medicine sequential therapy treatment (the basic formula is ginseng clam and green dragon soup, patients in the acute stage use the basic formula plus cicada slough, forsythia, Sichuan pei, fritillaries and other medicines, and add acupuncture point injection treatment for 2 courses; patients in the chronic persistent stage use the basic formula plus angelica, chasteberry, bone marrow and other medicines), the course of treatment is 12 weeks.

    • Therapeutic effect: it can reduce the number of attacks in patients with acute asthma, improve the symptoms of patients with asthma in the attack stage and chronic persistent stage, and improve the control of asthma patients.

    Prognosis

    Cure.

    The prognosis of allergic asthma varies from person to person and is closely related to the treatment regimen. With standardized treatment, clinical control of asthma can be as high as 95% in children and 80% in adults.

  • Harmful effects
    • 如治疗不规范导致反复急性发作，或少数难治性哮喘气道炎症持续控制不佳，可导致不可逆性气道重构，长期反复发作或感染可致慢性并发症。
    如慢性阻塞性肺疾病、支气管扩张、间质性肺炎、肺源性心脏病等。
  • Affects cardiopulmonary function
    • 哮喘患者尤其是年幼时起病或反复发作控制不佳者，往往引起胸廓畸形。
    最常见是桶状胸、鸡胸、肋骨外翻等胸廓畸形。
  • Causes thoracic deformity
    • 哮喘患者因反复发作，可出现抑郁、焦虑、恐惧、性格改变等。
    常有社会适应能力下降、自信心下降、交际减少等表现。

    Causes psychological disorders

    Daily

  • Daily management
    • 饮食以清淡（少油、少盐、少糖），避免食用辣椒、花椒、咖啡、咖喱等辛辣刺激性食物。
    避免进食硬、冷、油煎食物。若能找出与哮喘发作有关的食物，如鱼、虾、蟹、蛋类、牛奶等，应避免食用。
    某些食物添加剂如酒石黄和亚硝酸盐可诱发哮喘发作，应当引起注意，避免食入。
    保持营养均衡，多吃富含维生素、纤维素的食物，如蔬菜、水果等。
  • Dietary management
  • Medication management: Avoid medications related to asthma attacks, such as propranolol, neostigmine, aspirin, etc.
  • Environmental management: Get away from work environment prone to powder, dust and odor, such as flour milling, animal fur handling, painters, insecticide spraying, etc.
  • Emotional management: Avoid emotional tension and excitement. Appropriate reading, listening to music and other activities to regulate emotions.

    • Exercise management: Avoid strenuous exercise. After asthma control is stabilized, moderate walking and other low-intensity aerobic exercise can be carried out under the guidance of the doctor, and timely hydration is needed during exercise.

  • Follow-up
  • Importance of follow-up examinations: Regular follow-up examinations are crucial to the treatment effect of the disease.
  • Time for follow-up: Follow the doctor’s instructions for regular follow-up; if symptoms such as coughing or sudden breathlessness occur in daily life, it is recommended to consult the doctor immediately.

    • Tests needed at follow-up: Patients with allergic asthma may need to undergo lung function tests at follow-up.

    Prevention

    预防措施
  • Preventing the disease
  • Maintain environmental hygiene in the living room: House dust mites and fungi are the main allergens in the indoor air; sun bedding and open windows frequently for ventilation.
  • Do a good job of protection: reduce exposure to pollen and grass pollen in spring and fall, and reduce going out when air pollution is severe. Wear a mask when you have to go out, and take good personal protection.
  • Pay attention to the cold and keep warm: cold is easy to trigger asthma, season or fall and winter climate change in a timely manner to add clothing, avoid low-temperature stimulation, and do not blow the fan, air conditioning for a long time in summer.
  • Actively treat allergic rhinitis: Allergic diseases, especially allergic rhinitis, can cause asthma with repeated attacks. Active and effective treatment of these allergic diseases can reduce the occurrence of allergic asthma.
    • 参考文献
    [1]
    葛均波，徐永健，王辰．内科学[M]．9版．北京：人民卫生出版社，2018．
    [2]
    林果为, 王吉耀, 葛均波. 实用内科学[M]. 15版. 北京：人民卫生出版社，2017.
    [3]
    蔡柏蔷, 李龙芸. 协和呼吸病学[M]．2版．北京：中国协和医科大学出版社，2017.
    [4]
    尤黎明，吴瑛. 内科护理学[M]．6版．北京：人民卫生出版社，2017.
    [5]
    吴欣娟.中华医学百科全书[M]：护理学（二）. 北京：中国协和医科大学出版社，2016.
    [6]
    杨月欣，葛可佑. 中国营养科学全书[M]．2版．北京：人民卫生出版社，2019.
    [7]
    胡斌，李平立，文东菁，等．过敏性皮肤病血清总IgE和过敏原特异性IgE检测分析［J］．医学综述，2015，21( 8) : 1531- 1532．
    [8]
    宋继英，黎明新，徐秀艳，等．敏筛过敏原检测在儿科过敏性哮喘中的应用［J］．临床输血与检验，2015，17( 5) : 419 – 422．
    [9]
    赵莹，高英，陆彪．儿童喘息性疾病血清特异性IgE检测结果分析［J］．宁夏医科大学学报，2016，38( 6) : 679 – 681．
    [10]
    中华医学会呼吸病学分会哮喘学组．支气管哮喘防治指南（2020版）［J］．中华结核和呼吸杂志，2020，43（12）: 1023-1048.