Asthma, medically known as bronchial asthma, is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, dyspnea, chest tightness and coughing. This chronic inflammation causes a state of hypersensitivity in the airways, leading to airway obstruction and breathing disorders when various irritants are encountered. If left untreated, asthma can be very damaging to lung function, causing emphysema and even death.
In recent decades, the global prevalence and mortality of asthma have been increasing, and there are currently 300 million asthma patients worldwide, and 1/250 of all deaths worldwide are due to asthma, asthma has become a chronic respiratory disease that seriously threatens public health in the world today.
In China, the number of asthma patients has reached 30 million, and the morbidity and mortality rate has been on the rise in recent years. 2000 national pediatric asthma survey data show that the prevalence rate of urban children aged 0-14 years old in China is 0.15% to 3.14%, with an average of 1.94%, which is 1 times higher than 1990, and as high as 3.05% in our (Anhui) province. At the same time, WHO announced that the death rate of asthma patients in the age group of 5 to 34 years in China is as high as 36.7/100,000, which is one of the countries with the highest death rate of asthma in the world.
Asthma can occur at any age, but in recent years, epidemiological surveys have shown that the incidence of asthma is 84.8% before the age of 3.
Asthma attacks peak in autumn and winter
The onset of pediatric asthma is closely related to the seasons, and it is more likely to develop or recur in autumn and winter because in autumn, the right temperature and humidity make indoor dust mites multiply and the allergenic components in the air increase significantly, so the allergic inflammation in the airways of children with asthma increases and they are in a very sensitive and hyper-reactive state, which is medically known as “airway hyper-reactivity This is known as “airway hyperreactivity”. At this time, when the airways are stimulated by various external factors, such as inhalation of cold air, respiratory viral infections, etc., asthma will be triggered.
In addition, the climate is changeable in autumn and winter, and the temperature sometimes drops suddenly, making it difficult for children with asthma to adapt.
Coughing as the main symptom is not typical
Typical asthma attacks are very easy to diagnose, but some children only have a chronic cough, called “cough variant asthma” or “allergic cough”. This is called “cough variant asthma” or “allergic cough”.
It is characterized by a persistent cough >1 month; often attacks at night and/or early in the morning, aggravated by exercise, cold air or smell of a particular odor, low sputum, no clinical signs of infection such as fever or pus sputum, or ineffective after longer antibiotic treatment; and once some wheezing and anti-allergy drugs are used, the cough is clearly controlled. If this cough occurs, even if there is no obvious wheezing, you should seek medical attention in time to avoid delaying the condition.
Finding and avoiding allergens Reducing asthma attacks
Asthma is an allergic inflammatory disease of the airways. First of all, attention should be paid to finding allergens, and parents can take their children to the hospital for serum allergen testing or skin allergy testing. Dust mites, cockroaches, animal feathers and dander, pollen, fungi and many foods are common allergens, and some children are allergic to one substance, while others are allergic to several substances. Numerous studies have shown that not all asthma patients can find allergens, and not all allergic patients have asthma, but if you can find allergens, less exposure or no exposure to such substances, you can reduce asthma attacks.
1. Avoiding the following can improve asthma control and reduce the need for medication.
Smoking: Stay away from tobacco and neither the patient nor the child’s parents should smoke;
Medications, foods and additives: Avoid exposure if they are known to cause asthma symptoms;
2. It is recommended that exposure to the following substances be avoided as appropriate.
House dust mites: Wash sheets and blankets weekly in hot water and dry them in a dryer or in the sun. Wrap pillows and cushions in an airtight jacket. Replace carpets with hard flooring (especially in bedrooms). If conditions permit, use a vacuum cleaner with a filter. Kill small insects with acaricides or tannic acid, but these operations must be done when the patient is not at home.
Pets: Do not keep fur-bearing pets such as cats, dogs, rabbits, etc., or take these pets out of the home, or at least out of resting areas, and clean them frequently;
Cockroaches: Clean frequently and thoroughly and use insecticide sprays, but make sure the patient is not home when the sprays are used.
Outdoor dust and mold: Close doors and windows and stay indoors when there is a high amount of pollen, dust and mold (e.g., rainy season followed by sunny and windy days, straw burning season), and wear a mask when outdoors;
Indoor mold: reduce indoor humidity, often clean the wet areas.
Strengthen care to enhance physical fitness
Parents should pay attention to the child’s cold and warmth according to the climate change, timely increase and decrease clothes to prevent cold and flu. Pay attention to the child’s daily diet, provide adequate nutrition, and eat more food rich in protein, vitamins and trace elements, such as lean meat, poultry eggs, soybean products and vegetables, fruits and vegetables, to enhance the ability to resist diseases. Prevent children from being overly tired, ensure enough sleep, strengthen physical exercise, enhance physical fitness, and improve the body’s adaptability and tolerance to climate change.
Patients with moderate to severe asthma should receive annual influenza vaccination. Inactivated influenza vaccine is safe for adults and children over 3 years of age.
Although physical activity can sometimes trigger an asthma attack, children with well-controlled asthma can participate in a variety of physical activities exactly as normal, and the appearance of asthma symptoms after activity often indicates inadequate treatment measures and failure to control asthma well. It is now advocated that children with asthma should be allowed to live the life of a normal child and should not avoid activities. Regular participation in some appropriate physical exercise is beneficial to the physical development and physical and mental health of the child. Children with asthma are prone to asthma attacks due to emotional stress, long-term inactivity and poor resistance to disease.
Patients with exercise asthma can effectively prevent attacks by inhaling fast-acting beta2 agonists or taking leukotriene modifiers before strenuous exercise.
Asthma and genetics
Asthma is a polygenic genetic disease, meaning that the child with asthma has an asthma susceptibility gene or allergic constitution, which is often referred to as an endogenous cause, but it requires a combination of environmental factors or triggers (exogenous factors) to develop.
From the clinical point of view, children with a family history of asthma are prone to asthma. If both parents have asthma, the chance of their children having asthma is as high as 60%, if one parent has asthma, the chance of their children having asthma is 20%, if the parents do not have asthma, the chance of their children having asthma is only 6%, and if there are more people with asthma in close relatives, the next generation is also prone to asthma.
Diagnostic points of asthma in children
1.The majority of wheezing that occurs in children over 5 years old is asthma;
2. The younger the child, the greater the likelihood of recurrent wheezing caused by other causes such as viral infections and congenital abnormalities of the airways;
3, whether a child with wheezing before the age of three develops asthma later can be predicted by the following risk factors: if the child has one of the two major risk factors (i.e., a parent with a history of asthma or a child with a history of eczema); or two of the three minor risk factors (i.e., peripheral blood eosinophils > 4%, wheezing without cold symptoms and food allergy or allergic rhinitis), the risk of developing asthma by school age The risk increased 5 to 10 times by school age. If more than 3 episodes of wheezing have occurred in the past 1 year, 76% of children with asthma will have asthma by school age.
4, Symptoms are highly suggestive of an asthma diagnosis if they occur or worsen with: exposure to animal dander; chemical mist particles; temperature changes; house dust mites; medications (aspirin, beta-blockers); exercise; pollen; respiratory (viral) infections; smoke; and strong emotional expressions.
5. When diagnosing asthma in children, attention should be paid to exclude other causes of wheezing in children: such as foreign body aspiration; chronic sinusitis; gastroesophageal reflux; recurrent viral lower respiratory tract infections; bronchopulmonary developmental abnormalities; tuberculosis; congenital abnormalities of airway development; immunodeficiency disorders; congenital heart disease, etc.
Can pediatric asthma be cured without treatment? –Cure or not, not the same
Some parents think: “pediatric asthma will be fine by adult, it doesn’t matter if it is treated or not”, this idea is wrong and often misses the favorable time for pediatric asthma treatment.
Pediatric asthma is a chronic lung disease and it is difficult to cure it in a short period of time. However, for most children, asthma can be controlled with timely and systematic treatment. Many medications are available to control asthma, and with proper diagnosis and treatment, most children can achieve a “control” level: no day or night coughing, wheezing or awakening; no activity restriction; normal lung function; no acute attacks; and no need for emergency medications.
The majority of children are cured or self-resolved with prolonged control. Adolescence is an important opportunity for children with asthma to heal because of the gradual maturation of various organs and systems, especially the gradual improvement of endocrine function and immune regulation of the body, and the enhancement of the body’s ability to resist disease.
At this time, long-term airway inflammation and repeated asthma attacks often cause structural changes such as airway smooth muscle hyperplasia and hypertrophy, which is medically called “airway remodeling”, resulting in irreversible airway obstruction and even emphysema, which not only loses the chance to heal but also Lung function is severely damaged.
Although some children with asthma are “cured” without treatment, they have relapses after several years, and most asthma patients who develop asthma around the age of 40 have a past medical history of asthma as a child. Therefore, the active prevention and treatment of pediatric asthma is important for the prevention and treatment of adult asthma.
Over-pampered children tend to get asthma
Nowadays, children are the jewels of their families and are overly pampered. The widespread vaccination, use of antibiotics and reduced chance of bacterial infections inevitably lead to a lack of necessary exercise for the immune system of children and increase the chance of asthma. Many parents are afraid of their children getting sick and over-cleaning them, deliberately keeping them away from the natural environment, which makes them less exposed to certain bacteria and infections.
In fact, parents do not have to do so, because normal children can have 5-7 infections of various pathogens, such as colds, gastroenteritis, etc., every year before the age of 2, and each infection will cause the body to make corresponding adjustments, so that the immune system can be balanced and mature, which objectively reduces the chance of developing allergic diseases such as asthma in the future. This is the so-called “hygiene hypothesis” of asthma pathogenesis.
Desensitization therapy is important to persevere
Asthma is a kind of allergic or allergic disease. The main treatments for allergies are environmental control, medication and desensitization therapy. Environmental control is commonly referred to as staying away from allergens, but there are many allergens that cannot be avoided in life. Although drug therapy can effectively treat allergies, the application of simple anti-allergy drugs is sometimes difficult to obtain the desired effect when allergen exposure cannot be avoided. At present, standardized allergen-specific immunotherapy (commonly known as desensitization therapy) is carried out in some large hospitals, and its effectiveness has been highly recognized by domestic and foreign experts.
Desensitization therapy generally starts with a low dose, injected or sublingual once or twice a week, and then gradually increases the dose and gradually extends the interval between each dose after reaching the maintenance dose or the maximum tolerated dose, with the course of treatment being more than two years. To obtain the desired effect, children and parents must adhere to a regular treatment. Some patients stop taking the medication or extend the interval of treatment after the effect is achieved, which will affect the effect of treatment.
Before doing desensitization, it is important to first do allergen testing to look for allergens and to make sure that desensitization is not done during an asthma or other allergic attack. If you experience an acute asthma attack during desensitization, you should stop the desensitization treatment and resume it after the coughing and wheezing is controlled. Strenuous exercise should be avoided on the day of desensitization. If allergic reactions such as rash and chest tightness occur, they should be reported to the doctor in a timely manner.
Desensitization therapy is to make preparations of different concentrations of those common but unavoidable allergens, such as pollen and dust mites, and give them to patients regularly from low to high concentrations by injection or sublingual administration. Through repeated exposure to the specific allergen, the patient develops tolerance to the allergen, and the onset of symptoms is significantly reduced or does not occur when exposed to these allergens in the future. Desensitization therapy is suitable for patients with various allergic diseases, such as bronchial asthma, allergic rhinitis, allergic conjunctivitis, hay fever and skin allergy, etc. It is especially effective in treating asthma caused by inhaled allergens.
Correct treatment of asthma Eliminate misunderstandings
Treating the cause, avoiding allergic substances as much as possible, and carrying out desensitization to improve the body’s resistance to disease can reduce asthma attacks, etc. However, many asthma patients are allergic to a variety of factors in the environment, and it is almost impossible to completely avoid exposure to these factors.
Therefore, medications to maintain asthma control become very important because when asthma is controlled, the patient is less sensitive to these risk factors. Current asthma treatment drugs can be divided in principle into two categories: “long-term control drugs” and “rapid relief drugs”: asthma control drugs include inhaled glucocorticoids (ICS), long-acting β2 agonists (must be combined with ICS), leukotriene Inhaled glucocorticoids (ICS), long-acting β2 agonists (must be combined with ICS), leukotriene modulators, slow-release theophylline, etc.; and fast-acting β2 agonists, inhaled anticholinergics, short-acting theophylline, etc. are commonly used for relief.
Inhaled glucocorticoids (ICS) are the first choice for long-term control of asthma, with the advantages of direct action on the airway mucosa through inhalation, strong local anti-inflammatory effects and few systemic adverse effects. However, children with asthma of different ages require different inhalation devices so that the inhaled drug can reach the small airways in order to have a therapeutic effect. Inhaled rapid-acting β2 agonists are the drugs of choice to relieve asthma symptoms, and are generally used for short periods or temporarily when asthma symptoms are present.
The standardized treatment regimen for asthma and the course of medication varies from person to person, and the guidance of a specialist should be sought. In general, it is important to first evaluate the control of the child’s asthma and then select a treatment regimen that will allow the child to obtain asthma control, while continuously monitoring to maintain asthma control.
Continuous monitoring of asthma symptoms and lung function is an important way to understand whether the child’s condition is under control or not. A simple lung function meter, peak flow tachymeter, is commonly used clinically for monitoring, and blowing the peak flow tachymeter once a day in the morning and evening is like constantly measuring the blood pressure of a hypertensive patient, which can give a general idea of the child’s condition control and thus guide the treatment.
The peak flow tachometer is inexpensive (a few dollars) and easy to operate (you only need to blow the peak flow tachometer once a day in the morning and evening), so children with asthma over 4 years old can buy a peak flow tachometer, monitor it continuously at home, and record the results of each monitoring, which is often called “asthma diary”. This is often referred to as an “asthma diary”. When following up with a patient, the physician can use this “asthma diary” to determine how well the child’s condition has been controlled over time.
Parents can also use the results of the peak flow velocity monitor to detect any deterioration in the child’s condition or asthma attack. For example, a sudden drop of more than 30% in the peak flow rate of the child indicates a possible attack at any time.
Many parents of children with asthma have many misconceptions about the treatment of asthma, such as the use of antibiotics to “reduce inflammation” once the symptoms of cough and wheeze appear, not knowing that asthma is an allergic inflammation rather than an infectious inflammation, and in the absence of a combined bacterial infection, antibiotics to “reduce inflammation “The second is the belief that long-term glucocorticoid inhalation has side effects. Secondly, they think that long-term inhaled glucocorticosteroids have great side effects and affect the growth and development of children, and are unwilling to adhere to preventive treatment, and often have recurrent attacks and frequent intravenous infusions.
In fact, the dosage of inhaled glucocorticosteroids is very small and the systemic adverse effects are few, which is the first choice of drugs recommended by WHO for the treatment of asthma. In acute asthma attacks, a large amount of glucocorticosteroid is often infused intravenously, and the dose of 3 days of infusion is generally equivalent to the dose of inhaled hormone for more than half a year, so you can imagine that the latter has more side effects. There are also people who stare at all kinds of “miracle cure” for asthma every day, trying to get rid of the disease in a few days, once and for all. Imagine if there was such a panacea to solve the serious global public health problem of asthma, must be able to win the Nobel Prize in medicine.
Various commonly used peak flowmeters.
Commonly used inhalation devices – mist storage tanks