Asthma is one of the most common chronic respiratory diseases in the world today, and there are 300 million asthma patients worldwide. In the past 20 years, the prevalence of asthma has increased in the United States, the United Kingdom, Australia and other countries, and the situation in China is similar. 2002 epidemiological survey results of childhood asthma in China showed that the prevalence of 0.5% to 3.3% within 2 years, an increase of 64.8% compared to 10 years ago. It is estimated that there are as many as 20 million asthma patients in the country. Therefore, asthma has become a serious public health problem and has attracted great attention from all over the world.
The essence of asthma is chronic inflammatory airway metaplasia. For a long time, its treatment has been limited to temporary relief of acute symptoms, and at one time the mortality rate of asthma was significantly increased due to inappropriate application of bronchodilators. The advent of inhaled hormones and their use as the control drug of choice brought a qualitative breakthrough in this field. The subsequent introduction of leukotriene modulators and inhaled long-acting β2 agonists has improved and made the treatment of asthma even more powerful.
Definition of bronchial asthma
Bronchial asthma is a chronic inflammatory disorder of the airways involving a variety of cells (e.g., eosinophils, mast cells, T lymphocytes, neutrophils, and airway epithelial cells) and cellular components. This chronic inflammation leads to airway hyperresponsiveness, which results in airway obstruction and airflow restriction when exposed to multiple irritants, resulting in recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, often occurring or worsening at night and/or early in the morning, with most children in remission with treatment or on their own.
Diagnostic criteria for asthma in children
I. Childhood asthma
(1) Recurrent attacks of wheezing, shortness of breath, chest tightness or cough, mostly related to exposure to allergens, cold air, physical or chemical stimuli, viral upper and lower respiratory tract infections, exercise, etc.; (2) scattered or diffuse expiratory phase-dominated rales can be heard in both lungs during attacks, with prolonged expiratory phase; (3) significant efficacy of bronchodilators; (4) wheezing, shortness of breath, chest tightness or cough caused by other diseases are excluded; (5) for children with symptoms (5) For children with atypical symptoms and croup in the lungs, any of the following bronchodilator tests may be used to assist in the diagnosis if appropriate, and asthma may be diagnosed if positive: (1) rapid-acting β2 agonist nebulizer solution or aerosol inhalation; (2) subcutaneous injection of 0.01 ml/kg of 0.1% epinephrine (maximum of 0.3 ml/time). Within 15-30 min after any of the above tests, a positive result was obtained if wheezing was significantly relieved and croup was significantly reduced. children over 5 years of age who were available could have peak expiratory flow rate (PEF) or force expiratory volume in the first second (FEV1) measured before and after treatment, and a rise of ≥15% after treatment was considered positive. If croup is not heard in the lungs and FEV1 is >75%, a bronchial excitation test can be performed and a positive result can be diagnosed as asthma.
In infants and children the following should be noted.
1. Some infants and children whose initial symptoms are recurrent or persistent cough, or wheezing during respiratory infections, are often misdiagnosed as bronchitis or pneumonia (including acute respiratory infection-ARI), so unreasonable application of antibiotics or cough suppressants is ineffective, and anti-asthma medication is effective at this time. The name of the diagnosis of “infantile asthma” is used.
2.If the child’s “cold” repeatedly develops into the lower respiratory tract and only improves after more than 10 days of treatment with anti-asthmatic drugs, then asthma should be considered.
3. At present, wheezing in infants and children is often divided into two types.
Atopic (eczema), whose wheezing symptoms often last throughout childhood and into adulthood.
Those without atopic constitution and family history of atopy, with recurrent wheezing episodes associated with acute respiratory viral infections, whose wheezing symptoms usually disappear by preschool age.
Regardless of the type of wheeze, airway hyperresponsiveness is present, and some atopic inflammation is present. To date, there is no definitive method to predict which children will have persistent wheezing. Since more than 80% of asthma starts before the age of 3 years, early intervention is necessary. Although there is a risk of overuse of anti-asthmatic drugs in some children, effective use of anti-allergic inflammatory drugs and bronchodilators is better than antibiotics in shortening or reducing wheezing episodes and is consistent with the principles of early diagnosis and management of childhood asthma.
4. In the diagnosis and treatment of wheezing in infancy and early childhood, special attention should be paid to the identification of bronchial foreign bodies, bronchial lymph node tuberculosis, congenital upper and lower airway malformations and other diseases that can have wheezing, shortness of breath or chest tightness.
Cough Variant Asthma
(1) persistent cough >1 month, often at night and/or early in the morning, aggravated by exercise, cold air or smell of special odor, low sputum, no clinical signs of infection, or ineffective after prolonged antibiotic treatment; (2) diagnostic treatment with bronchodilators can relieve cough attacks (basic diagnostic condition); (3) personal or family history of allergy, family history of asthma, allergen (allergen) test Positive allergen (allergen) tests can be used as an auxiliary diagnosis; (4) exclusion of other causes of chronic cough.
Staging of asthma
In order to facilitate standardized treatment and management, the whole course of asthma is divided into acute exacerbation, chronic persistence and clinical remission according to the clinical manifestations and lung function of the child. Clinical remission is defined as the disappearance of symptoms and signs and the maintenance of FEV1 or PEF ≥ 80% of the expected value for more than 4 weeks.
Assessment of the severity of asthma
It can be divided into three parts.
1. Assessment of the severity of the child’s disease. This includes children with new-onset asthma and children who have been previously diagnosed with asthma and have not been treated with medication for a long time. The assessment was generally based on the frequency and extent of wheezing episodes and lung function in the month before the start of treatment, and was divided into 4 grades (Table 1).
Table 1 Judgment indexes for grading the severity of asthma
Grade
Daytime symptoms
Nocturnal symptoms
PEF or FEV1 as a percentage of expected value (%)
PEF variation rate (%)
Grade I
(mildly intermittent)
< 1 time/week
Asymptomatic between seizures
≤ 2 times/month
≥ 80
1 time/week
60～80
> 30
Grade IV
(Severe persistent)
Persistent symptoms
Limited physical activity
Frequent
≤ 60
> 30
2. Assessment of the severity of the child’s disease during the period of standardized treatment. When the child is already in the period of standardized treatment (generally 1 month), the child whose condition is not satisfactorily controlled should be re-evaluated for the severity of asthma, and the actual severity level of the child’s condition should be determined based on the comprehensive judgment of the severity of his or her current condition and the level before treatment to guide the next step of treatment (Table 2).
Table 2 Principles of asthma severity and re-integrated determination of level after standardized treatment
Determined before treatment
Disease level
Mild intermittent
Severity after treatment Mildly persistent
Degree
Moderately persistent
Severe persistent
Mildly intermittent (Grade 1)
Mild intermittent or persistent
Mildly persistent
Moderately persistent
Severe persistent
Mildly persistent (secondary)
Mildly persistent
Moderately persistent
Severe persistent
Severe persistent
Moderately persistent (Grade III)
Moderately persistent
Severe persistent
Severe persistent
Severe persistent
Long-term standardized treatment regimen
There are two regimens depending on age.
The starting dose is decided according to the severity (level) of asthma. If a larger dose of inhaled glucocorticoids is chosen at the beginning of treatment, the dose should be reduced relatively quickly to the most appropriate effective dose in this level that can control asthma attacks over a period of 2 to 3 months. At all levels of treatment, the regimen should be reviewed every 1 to 3 months, and once symptoms are controlled should be consolidated for at least 3 months and then tapered until the minimum dose to maintain asthma control is determined. If asthma is not controlled, escalate treatment immediately, but first check the child’s aspiration technique, compliance with the medication regimen, and avoidance of allergens and other triggers, etc. This is the stepped treatment regimen for asthma.
1. Long-term treatment regimens for asthma in children over 5 years of age (Table 3).
Table 3 Long-term treatment regimens for children over 5 years of age with different severity of asthma
In all grades, in addition to regular daily use of controller therapy medications, inhaled rapid-acting β2 agonists and/or anticholinergics should be used if symptom relief is needed, but not more than 3 to 4 times in 1 day.
Class
Long-term controlled medication
Other treatment options
Grade I
Mild intermittent
Some children may inhale low-dose glucocorticoids
Hormone 100-200μg/d
Oral bronchodilator or inhaled rapid-acting β2 agonist as needed
or: leukotriene modulators
Secondary
Mild continuous
Inhaled glucocorticoids 100-400μg /d
(may + inhaled long-acting β2 agonist)
Slow-release theophylline
OR: leukotriene modulator
OR::Inhaled sodium cromoglycate pMDI 10 mg 2 to 3 times daily
Tertiary
Moderate continuous
Inhaled glucocorticoid 200-400 μg /d
+ Inhaled long-acting β2 agonist
Or: Inhaled glucocorticosteroid 400～600μg /d
Inhaled glucocorticoids 200-400μg /d + slow-release theophylline
Or: Inhaled glucocorticoid 200-400μg/d + oral long-acting β2 agonist
Or: Inhaled glucocorticoid 200-400μg /d + leukotriene modulator
Grade IV
Severe persistent
Inhaled glucocorticoids 400-800μg /d
+ Inhaled long-acting β2 agonist
Or: Inhaled glucocorticoids >800μg/d
If needed, add 1 or more of the following drugs
Extended-release theophylline
Leukotriene modulator
Oral long-acting β2 agonist
Oral glucocorticoids
Notes.
(1) Children with mild intermittent exacerbations, once severe asthma exacerbations occur, are treated on a moderate persistent (tertiary) or severe persistent (quaternary) regimen.
(2) Cough variant asthma is treated as grade I (mild intermittent).
(3) If asthma is accompanied by rhinitis or sinusitis, the appropriate treatment should be given, and appropriate antibiotics can be applied if there is a combination of infection.
2. Long-term treatment options for asthma in children under 5 years of age (Table 4).
Table 4 Long-term treatment regimens for asthma in children under 5 years of age
In all grades, in addition to the regular daily use of control therapy medications, inhaled rapid-acting β2 agonists and/or anticholinergic drugs should be used if symptomatic relief is needed, but not more than 3 to 4 times in 1 day.
Grading
Long-term control medication
Other treatment options
Grade I
(mildly intermittent)
Some children may inhale low-dose glucocorticoids
hormone 100-200μg/d
Oral bronchodilator or inhaled rapid-acting β2 agonist as needed
Or: leukotriene modulators
Grade II (mildly persistent)
Inhaled glucocorticoids 100-400μg /d
Oral extended-release theophylline or leukotriene modulator or inhaled sodium cromoglycate pMDI 10 mg , 2 to 3 times daily
Tertiary
(moderate persistence)
Inhaled glucocorticoids 400-600 μg /d
Inhaled glucocorticosteroids 400-600 μg/d + slow-release theophylline
Or: Inhaled glucocorticoid 400-600μg/d + oral long-acting β2 agonist
Or: Inhaled glucocorticoids 400-600μg / d + leukotriene modulators
Grade IV
(Severe persistent)
Inhaled glucocorticoids 600-800μg /d
Or: nebulized inhalation of budesonide suspension 0.5 to 1 mg twice daily
If needed, add 1 or more of the following drugs
Extended-release theophylline
Leukotriene modulator
Oral long-acting β2 agonist
Oral glucocorticoids
Commonly used asthma drugs and treatment
In principle, commonly used asthma drugs can be divided into two categories: long-term control drugs and rapid relief drugs: asthma control drugs include glucocorticoids, long-acting β2 agonists, leukotriene modulators, extended-release theophylline and cromoglycate, etc.; while relief drugs commonly used include short-acting β2 agonists, theophylline and anticholinergic drugs.
I. Glucocorticoids
They are the most effective anti-inflammatory drugs, and their main mechanisms of action include ① interfering with arachidonic acid metabolism, reducing leukotriene and prostaglandin synthesis; ② inhibiting eosinophil chemotaxis and activation; ③ inhibiting cytokine synthesis; ④ reducing microvascular leakage; ⑤ increasing β2 receptor synthesis on cell membranes; ⑥ reducing airway hyperresponsiveness, etc. The routes of administration are generally inhalation, oral and intravenous.
(1) Inhalation: Inhaled glucocorticoids are the first choice for long-term control of asthma, with the advantage that through inhalation, the drug acts directly on the airway mucosa, with strong local anti-inflammatory effects and few systemic adverse effects. It usually requires long-term and standardized inhalation to play a preventive role. In acute asthma attacks, beta2 agonists should be inhaled first, followed by glucocorticoids. For children with seasonal asthma attacks, continuous, regular inhaled glucocorticoids can be started 2 to 4 weeks before the expected attack. The maintenance dose of inhaled glucocorticosteroids in children is 200-400 μg per day. local adverse effects include hoarseness, pharyngeal discomfort and oral Candida infection, which can be reduced by rinsing the mouth with water, adding a storage mist canister or choosing a dry powder inhaler. There are three types of drugs currently on the market: beclomethasone propionate, budesonide and fluticasone propionate, of which the latter two have fewer systemic adverse reactions and stronger effects. Their dosage forms can be divided into 3 categories.
① Pressure quantitative inhalation aerosol (pMDI): the above 3 types of glucocorticoids are clinically used, and their dose interchangeability is shown in Table 6.
② Dry powder inhalers: There are budesonide duplex, fluticasone propionate discs and beclomethasone propionate capsules. (ii) Dry powder inhalation is more convenient than pressure quantitative inhalation aerosol (pMDI), and the amount of inhaled lower respiratory tract drugs is higher.
(3) Nebulized solution: there is budesonide suspension, nebulized by a jet device powered by compressed air or high-flow oxygen for inhalation, the requirements for inhalation cooperation of children are not high, the onset of action is faster, all ages can be applied, suitable for acute exacerbation treatment, also long-term inhalation for prophylaxis, 0.5 to 1 mg/time, 1 to 2 times a day.
(2) Oral administration: children with acute exacerbation and poor efficacy of inhaled high-dose hormones can be prevented from deterioration by adding oral glucocorticoids early. Short-term oral prednisone should be given for 1-7 days at 1-2 mg/kg per day (not more than 40 mg in total) in 2-3 doses. However, long-term oral prednisone or dexamethasone should be avoided because of the side effects of long-term oral prednisone or dexamethasone, especially in children who are growing and developing.
(3) Intravenous administration: For severe asthma attacks (severe), intravenous medication should be given early, commonly used drugs are methylprednisolone 1~2 mg/kg or hydrocortisone succinate 5~10 mg/kg, 2~3 times a day, generally short-term application, discontinued within 2~5 days. If glucocorticoids are used continuously for more than 10 d, they should not be stopped suddenly and should be maintained in reduced doses to avoid relapse.
β2 agonist
It is the most widely used bronchodilator in clinical practice, especially aerosol inhalation is widely used in the treatment of acute asthma attacks. It mainly excites β2 receptors on the surface of airway smooth muscle and mast cells, relaxes airway smooth muscle, reduces mast cell and basophil degranulation, prevents the release of inflammatory mediators, reduces microvascular permeability, increases epithelial cell cilia function, and relieves wheezing symptoms. β2 agonists can be divided into two categories: short-acting and long-acting, and the latter can also be divided into two types: fast-acting and slow-acting.
1, short-acting β2 agonists: commonly used are salbutamol and terbutalin. There are 2 types of dosage forms.
(1) Inhalation administration: the most commonly used, including aerosol, dry powder and nebulized solution, acting directly on the bronchial smooth muscle, with a rapid effect on asthma, usually within a few minutes, the effect can be maintained for 4-6 h. It is the drug of choice for the relief of acute symptoms of asthma, and can also be used as a preventive drug for exercising asthma. Systemic adverse effects (e.g. palpitations, skeletal muscle tremors, cardiac rhythm disturbances, hypokalemia) are mild and should be used as needed. Salbutamol 100-200 μg per inhalation; terbutaline 250-500 μg per inhalation. long-term single use is not advisable, if the dosage exceeds 4 times a day or ≥ 2 cans of aerosol per month should be used under the guidance of a physician or the medication should be adjusted. In case of severe asthma attack, short-acting β2 agonist solution can be inhaled once every 20 minutes during the first hour, and then once every 2 to 4 hours according to the condition.
(2) Oral administration: salbutamol and terbutaline tablets are commonly used, often taking effect 15-30 min after oral administration and maintaining for 4-6 h. They are generally used for children with mild to moderate persistence, 3-4 times a day, and palpitations and skeletal muscle tremors are more common than inhalation. Salbutamol tablets: 0.1-0.15 mg/kg, 2-3 times daily; terbutaline tablets: 65 μg /kg, 3 times daily.
Long-term application of short-acting β2 agonists (including inhalation and oral) can cause down-regulation of β2 receptor function and decrease in drug efficacy, which can be restored after a period of discontinuation.
(1) Salmeterol (Salmeterol): administered by aerosol or disc device, takes effect after 30 min of inhalation and is maintained for more than 12 h.
(2) Formoterol (Formoterol): administered by aerosol or DuPao device, inhalation 3-5 min onset of action, maintain 8-12 h, asthma effect with agent
2) Long-acting β2 agonists: these drugs have long side chains in the molecular structure, with strong lipid solubility and high selectivity for β2 receptors, with strong and long-lasting effects (10-12 h); can reduce airway hyperresponsiveness; can be used in combination with glucocorticoids to reduce the latter’s dosage, with synergistic effects; not easy to produce drug resistance; minimal cardiovascular effects. There are often the following types: dose-dependent. Mostly used to prevent nocturnal asthma attacks, in addition to the rapid onset of action of the drug, can be used as needed for the treatment of acute asthma attacks.
(3) Procaterol hydrochloride: oral 15-30 min onset of action, maintenance 8-10 h, also has anti-allergic effect, 6 years: 1.25 μg/kg or 0.25 ml/kg, 1 to 2 times daily; 6 years: 25 μg or 5 ml, 1 to 2 times daily.
(4) Bambuterol: long-lasting oral action, half-life of about 13 h. Available in tablets and syrup. 2-5 years: 5 mg or 5 ml; 5-12 years: 10 mg or 10 ml, once daily at bedtime.
The combination of inhaled glucocorticoids and long-acting β2 agonists is recommended for the treatment of asthma. The combination has synergistic anti-inflammatory and wheezing effects and can achieve efficacy equivalent to (or better than) that of inhaled doubled doses of glucocorticoids, and can increase the compliance of children and reduce the adverse effects of larger doses of glucocorticoids, especially for the long-term treatment of children with moderate to severe asthma.
C. Theophylline
Theophylline has the effects of diastolic airway smooth muscle, cardiotonic, diuretic, coronary artery dilation, respiratory center and respiratory muscle excitation, and low blood concentration theophylline has certain anti-inflammatory and immunomodulatory effects.
Theophylline must reach a blood concentration of 10-15 mg/L when used for rapid remission, and is not the drug of choice for bronchodilatation. In critically ill patients and those who have not used theophylline within 24 h, the first dose loading dose is 4-6 mg/kg, added to glucose solution for 20-30 min intravenously, and then maintained at 0.75-1 mg/(kg?h). ＜Those who are <2 years old, have used theophylline within 6 h, or whose medical history asks whether they have used theophylline preparations, are not given a loading dose but are directly administered with 1 mg/(kg?h) by sedation. For long-term users, it is best to monitor the blood concentration of theophylline.
When theophylline is used as a long-term controller, it mainly assists inhaled glucocorticoids as an anti-inflammatory agent with an effective blood concentration of 5 mg/L. If common theophylline is used, 10 mg/kg per day is given orally in 3 doses. It is advocated to use slow-release (or controlled-release) theophylline, divided into 1 or 2 doses daily to maintain stable blood concentrations around the clock, mostly for the prevention of nocturnal asthma attacks and nocturnal cough.
The effective blood concentration of theophylline has a narrow safety window. Common adverse reactions include gastrointestinal (nausea, vomiting) and cardiovascular (arrhythmia, decrease in blood pressure). Overdose can cause convulsions, coma and even death. Fever, liver disease, heart failure, combined with macrolide antibiotics, metformin and quinolones will increase its adverse reactions, and when combined with ketotifen can increase the clearance rate and shorten its half-life, should avoid simultaneous use or adjust the dosage.
Fourth, anticholinergic drugs
Inhaled anticholinergic drugs, such as ipratropium bromide, can block the postganglionic vagus nerve efferent branch, which can relax the bronchus by reducing the vagal tone. It is often used in combination with β2 agonists to enhance and sustain the bronchodilatory effect. Some children with asthma have obvious adverse reactions to larger doses of β2 agonists, and can be replaced with this drug, especially for children with nocturnal asthma and sputum.
V. Leukotriene modulators
It can inhibit leukotriene activity in airway smooth muscle and prevent and inhibit leukotriene-induced increase in vascular permeability, airway eosinophil infiltration and bronchospasm, and can reduce allergen, exercise and SO2-induced bronchospasm. Leukotriene modulators can be divided into leukotriene receptor antagonists (montelukast, zallust) and leukotriene synthase inhibitors. They are mainly used in allergen (allergen)-induced asthma, exercise-induced asthma, and aspirin-induced asthma. Combined with inhaled glucocorticoids for the treatment of children with moderate to severe persistent asthma, it can reduce the dose of glucocorticoids and improve the efficacy of inhaled glucocorticoids. The drug is well tolerated, has mild side effects and is easy to take. Montelukast: 6 to 12 years old, 5 mg once daily; 2 to 5 years old, 4 mg once daily. Zallustat: 7 to 11 years old, 10 mg twice daily.
VI. Mast cell membrane stabilizers
Disodium cromoglycate, which inhibits 1gE-mediated mast cell release mediators, also selectively inhibits other inflammatory cell release mediators. It is a non-corticosteroid anti-inflammatory agent, which is indicated for the long-term treatment of mild asthma. It also acts to prevent exercise-induced asthma and prevent wheezing attacks induced by dry and cold air, etc. It has very few side effects and can be used safely for a long time.
VII. Antihistamines
Oral antihistamines, such as cetirizine, loratadine, ketotifen, etc., can be used together, especially for children with obvious atopic constitution, such as with allergic rhinitis and eczema. The main adverse effect of ketotifen is drowsiness, and its use in children is not recommended.
VIII. Specific immunotherapy (SIT)
At present, asthma can be controlled satisfactorily by regular application of various drugs and the use of necessary preventive measures. When exposure to allergens cannot be avoided or when drug therapy is ineffective, allergen-specific immunotherapy can be considered. Allergy to pollen or dust mites can be treated with desensitization to the appropriate allergen extract to relieve asthma attacks, but attention should be paid to possible serious adverse reactions, including systemic allergic reactions (anaphylaxis) and severe asthma attacks. The long-term efficacy and safety of allergens should be further studied and evaluated, and the standardization and purification of allergen preparation should be strengthened and standardized.
IX. Immunomodulators
It can be added as appropriate for those who have wheezing attacks induced by recurrent respiratory tract infections.
Ten, Chinese medicine
Treatment should be based on evidence. During the acute attack period, the actual asthma and the deficiency asthma should be divided into the symptoms by attacking the evil and focusing on the lung and spleen; during the remission period, we should support the righteousness to strengthen the origin and focus on preventive treatment by tonifying the spleen, warming the kidney or promoting the lung.
Education and management
Asthma is a chronic disease. By educating children and parents about the basic prevention and treatment of asthma, we can mobilize their subjective motivation for asthma prevention and treatment, improve compliance, avoid various triggers, consolidate the treatment effect and improve the quality of life. At the same time, strengthening the education of medical and nursing staff and updating their knowledge of asthma prevention and control is also one of the indispensable links in asthma prevention and control.
I. Educational content.
The nature of asthma.
The various factors that trigger asthma attacks, how to find and avoid them.
The aura of asthma attack, symptom pattern and corresponding treatment.
Do daily self-monitoring, master the measurement method, recording and judgment of peak expiratory velocity meter, and learn to record asthma diary.
Understand the characteristics of various long-term control and rapid relief drugs, their use (especially inhalation techniques) and prevention of adverse reactions.
Learn the signs and symptoms of asthma exacerbation, emergency measures and indications for emergency treatment.
Education methods
The doctor and the patient (relatives) will work together to develop a treatment plan, and individual consultation and guidance can be provided.
Systematic asthma education through talks, exchange sessions, lectures, summer (winter) camps and fellowships.
Promote asthma knowledge through radio, television, newspapers, popular science magazines, books, etc.
Apply electronic network or multimedia technology to disseminate asthma prevention and control knowledge.
III. Management objectives
To enable children with asthma and their relatives to have a correct and comprehensive understanding of asthma prevention and treatment and good compliance, to adhere to treatment, not to believe in false advertisements, not to interrupt treatment, and to strictly prevent indiscriminate treatment.
To enable children with asthma and their relatives to have the ability to self-control the disease, prevent various triggers, control asthma attacks early, reduce the number of attacks, reduce the degree of attacks, and reduce asthma emergencies to a minimum or none.
To enable the child to maintain or approach normal lung function, improve the child’s quality of life, and allow him/her to participate in normal activities, learning, games and sports activities, and enjoy a healthy life.
To reduce the incidence of adverse drug reactions to a minimum or even none.
IV. Contents of long-term management
Based on hospital specialties, establish asthma home, asthma club, asthma fellowship and other organizations.
Through the community, it is included in the scope of community medical chronic disease management and regular monitoring.
Establish asthma patient files and long-term prevention and treatment plans.
Long-term and regular follow-up visits through various forms.
Long-term management of asthma must be based on strengthening asthma education, so that children with asthma and their relatives can take the initiative to cooperate with specialists and nurses, establish partnerships, receive regular guidance and follow-up visits, and establish the credibility of specialists and nurses is crucial.