Asthma can be controlled. It is understood that in China, many patients and their families still lack confidence and correct understanding in the treatment of asthma, and even listen to the so-called “biased” and “ancestral secret recipes” that can “cure asthma”. In addition to failing to control asthma, they cause serious adverse reactions. In order to make more asthma patients and their families understand asthma, master the scientific methods of asthma prevention and treatment, and let more patients get standardized treatment, and further promote the prevention and treatment of asthma in Shenzhen. In order to make more patients and families understand asthma and master the scientific methods of asthma prevention and treatment, and to further promote the prevention and treatment of asthma in Shenzhen.
I. Untimely diagnosis
Many parents and even some physicians are often reluctant to admit that a child with recurrent wheezing is asthmatic and diagnose it as bronchitis, bronchitis or wheezing bronchitis, and often use a lot of antibiotics in clinical treatment. Although antibiotics can kill bacteria, they cannot eliminate the allergic inflammation of asthma, thus delaying the valuable time for early diagnosis and treatment. Therefore, children with frequent coughing and wheezing should see a pediatric respiratory specialist as soon as possible, provide the doctor with a detailed medical history and treatment of the child, and conduct relevant tests to exclude other wheezing-causing diseases, so that a clear diagnosis can be made as soon as possible for early standardized treatment.
Inappropriate treatment
With regard to the treatment of asthma, inhaled glucocorticoids are now considered to be the most effective “control medication” for children of all ages. Inhalation therapy can deliver the drug directly to the airways that need treatment, and its efficacy is certain with few systemic adverse effects. However, the following problems still exist.
1. Inappropriate application of hormones.
(1) Hormone phobia: Many parents and even some doctors have fear of corticosteroids and worry that long-term application will affect the growth and development of children, thus not regulating or even refusing to use them. In fact, the current “Global Asthma Prevention and Control Initiative” was launched, using corticosteroid inhalation therapy with only 200~400 micrograms per day, which is the amount of one-fifth to one-third of a tablet of prednisone, and the amount of each time is negligible. At the same time, the inhaled drug can directly reach the target cells in the respiratory tract, with rapid onset of action and little systemic absorption, and even if part of it is absorbed, it can be metabolized and excreted in the liver within 2 hours. Therefore, the international asthma community unanimously recognizes that corticosteroid inhalation therapy is currently the most effective drug for controlling recurrent chronic asthma attacks and should be vigorously promoted.
(2) Inappropriate inhalation methods: Some physicians only prescribe inhalation therapy drugs without carefully teaching children and parents how to use them properly. For example, when using aerosols, deep inhalation and pressure on the aerosol device should be “synchronized” in order for the drug to enter the lower respiratory tract and play an anti-inflammatory role. Some doctors use dry powder inhalers for children under 4 years of age, but children under 4 years of age have difficulty in mastering the use of these dosage forms and therefore cannot inhale the medication into the lower airway, so their asthma is not controlled.
(3) Insufficient course of treatment and easy to relapse: Because asthma is a chronic disease, we should realize that the treatment of asthma is a long-term process, parents should have patience and confidence, and should not stop or reduce the dosage casually when they see that the child’s condition is stable without an attack, which will cause the child’s condition to recur and affect the efficacy of treatment. Some parents treat their children for 1~2 months, and when the asthma attack is relieved, they think their children are cured and stop the treatment by themselves. Some parents are afraid of the hassle and delay, some are afraid of spending money, and some are lucky. As a result, the asthma comes back after a period of time. Therefore it is important to repeatedly emphasize the regularity, adherence and phase of inhalation therapy (i.e. step-down therapy). Review the treatment plan every 1~3 months and evaluate the asthma control, if the asthma is controlled for at least 3 months, then the treatment can be gradually downgraded. If asthma is not controlled, escalate treatment immediately, but first check the child’s inhalation technique, compliance with the medication regimen, and avoidance of allergens and other triggers. It is also important to clarify that asthma is not cured in the short term and that 1 course of treatment usually has to be adhered to for at least a year before clinical cure is possible. A few children with long and severe disease course should be extended.
2, antibiotic treatment of asthma: asthma is a chronic inflammatory disease of the respiratory tract, but this inflammation is a kind of metabolic inflammation, completely different from the inflammation caused by bacterial infection. Therefore, antibiotics effective in treating bacteria are ineffective in treating the inflammation of asthma. Asthma treatment needs to be reasonable against allergic inflammation, with inhaled glucocorticoids preferred over antibiotics, and there is no need to abuse antibiotics. Regular use of antibiotics is necessary only when a child with asthma has a concurrent bacterial infection.
3. Treat only when an attack occurs: an asthma attack is only the tip of the iceberg, and chronic respiratory inflammation still exists even without asthma symptoms. Most children with asthma still have varying degrees of small airway dysfunction in remission, with FEV25 and FEV50 being the two most significant. Only by adhering to standardized treatment can the inflammation be completely eliminated so that asthma is completely controlled and no more attacks occur. Due to the limited understanding and medical treatment of asthma in the past, only symptoms could be relieved during an attack. And this systemic drug treatment with great adverse effects was only a treatment of last resort. Inhaled surface corticosteroid therapy is now considered to be the current treatment of choice for asthma, and under the guidance of a physician, this treatment is harmless and safe. This is because inhaled hormones only act locally on the airways and the amount of hormone inhaled is much less than the amount given orally or intravenously. The program believes that asthma should be standardized even when it does not attack, so as to achieve the goal of controlling asthma with only few drugs.
III. Insufficient awareness of the disease
Treating asthma is a long-term process. Parents of children with asthma tend to go to two extremes. First, they do not pay enough attention to their children’s condition, do not know enough that asthma is a chronic respiratory tract inflammation, are not prepared for long-term medication, pay attention to treatment during asthma attacks but neglect treatment during remission, reduce or stop medication on their own when their condition improves slightly, or even adopt a laissez-faire attitude towards the condition. At the same time, they do not pay attention to keep the children away from allergens, and they wrongly believe that pediatric asthma will be cured by itself when they grow up. At the other extreme, parents are overly sensitive to their children’s condition, and their nervousness will in turn have a negative impact on their children. Some parents are also psychologically burdened and most are reluctant to admit that their children have asthma, which affects timely treatment. In fact, most children with asthma can be clinically cured if they are treated regularly.
Therefore, the following points should be emphasized in the treatment.
(1) Parents should pay attention, have the right attitude and confidence, master their knowledge of prevention and treatment, treat their children correctly, and neither overindulge nor be overly strict. Children suffering from recurrent asthma attacks are painful and prone to depression, low self-esteem and fear. These psychological changes can reduce the immune function of the body, thus triggering asthma attacks, so it is necessary to help the child establish a good psychological state.
(2) Advocate children to actively participate in physical activities, do not be afraid of sports, but must be scientific and reasonable. Such as jogging rather than strenuous long-distance running; can swim but not in colder water. The amount of exercise should not be too large and not too strenuous. Regular aerobic exercise that is not very heavy and consistent can improve the resistance of the affected child. Although exercise is a risk factor for asthma, it is not a contraindication for children with asthma. As long as asthma is controlled through standardized control measures, children with asthma can and should participate in sports.
(3) Children with asthma can be allowed to exercise systematically and systematically from summer to increase the body’s ability to adapt to cold. The process should be gradual, so as not to cause excessive cold. Not only will children with asthma not be afraid of cold in winter, but the number of asthma attacks will also be reduced after cold tolerance exercise.
Fourth, the management education is not strong enough
Management education for asthma is very important. Through health education, children can understand the concept, etiology and triggering factors of asthma, learn the correct way to use inhaled drugs, master the use of peak flow rate meter, be able to predict asthma attacks, as well as master the first aid measures in case of sudden attacks, and understand their condition, reduce their worries, enhance their self-confidence, improve their compliance with medication, and improve their overall The program is designed to help children with asthma manage their asthma in the long term by improving their self-management skills. Let children with asthma study and live like healthy children, seek the support of family, friends and society, which is conducive to asthma treatment, improve children’s awareness of self-preservation keys, maintain a good state of mind, and actively participate in asthma treatment and attack prevention.
In conclusion, the treatment of asthma is long-term, and only by establishing a good physician-patient-family partnership, we can strive for the active participation of the children in treatment and prevention. While treating and educating children, physicians should respect the right to know of children and parents and improve their understanding of the nature of asthma through asthma education, fully informing parents and children about the condition, diagnosis, medication, course of treatment, price and precautions. We should also relieve the children’s tension, help them build up confidence and courage to overcome the disease, and improve their compliance with prevention and treatment in order to reduce asthma attacks, maintain long-term stability, improve quality of life, and reduce medical expenses.