As a common chronic disease, asthma has become a serious public health problem worldwide, affecting people of all ages. Severe asthma attacks can be fatal, and both genetic and environmental factors are involved in the development of asthma. The role of abnormal immune responses in the development of asthma has been the focus of attention and research. The 1993 Global Initiative for Asthma (GINA) was the first to provide guidance on the diagnosis and treatment of asthma based on the best available research, and the 2002 edition of GINA updates the latest research findings in asthma management and prevention, with an emphasis on analyzing and evaluating the reliability of this research evidence, The 2005 GINA protocol collected 298 papers on asthma management and prevention from January to December 2004, of which 25 papers were identified by experts to be added to or replaced existing references, and new ideas were introduced as part of the recommended management and prevention protocol.
I. New literature and perspectives on childhood asthma prevention and control in the 2005 GINA program
In the section of tertiary prevention of asthma on “avoidance of indoor allergens”, Morgan et al. were quoted as having published a paper suggesting that comprehensive family-based environmental interventions could reduce the incidence of allergic asthma in children.
2. Regarding vaccination for asthmatics, annual influenza virus vaccination is recommended for patients with moderate to severe asthma. However, routine influenza virus vaccination for children and adults with asthma does not protect patients from acute asthma attacks. Inactivated influenza virus vaccine has few adverse effects and is safe for adults and patients with asthma over 3 years of age, including severe asthma. There are data that intranasal vaccination increases acute asthma attacks in children under 3 years of age.
3.In acute asthma attacks, a dosing inhalation device with a storage canister can be used instead of nebulized inhalation of β2 agonists.
4.For children aged 1 to 3 years with asthma, low-dose inhaled glucocorticosteroid treatment is better than treatment with sodium cromoglycate.
5. For the prevention and treatment of wheezing in infants and children, two papers published by Bisgaard et al. were added to further confirm the effectiveness and safety of inhaled co-corticosterone.
The overall trend is that the incidence of asthma is increasing, but the reasons for this are not clear. There are no reports of systematic studies on the relationship between parasitic infections and asthma development.
The 2005 GINA protocol for the diagnosis of asthma in children
The 2005 GINA protocol still places childhood asthma among the particularly difficult to diagnose asthma. The 2005 GINA protocol states that asthma is one of the most common chronic diseases, and that the incidence of asthma is increasing, especially in children. The incidence of asthma is increasing, especially in children. In most children, asthma is manageable. The diagnosis of asthma is based on a history of recurrent wheezing, clinical manifestations during an attack, and pulmonary function tests, in addition to other diseases. Diagnostic treatment is also one of the effective methods to diagnose pediatric asthma.
Classification of wheezing in infants and children in the 2005 GINA program
The 2005 GINA program classifies wheezing in infants and children into two categories: wheezing associated with viral infections, where the child is not atopic and has no positive family history of allergic diseases, and the wheezing symptoms usually disappear by preschool age. The second type of wheezing has an atopic constitution, and the wheezing symptoms persist throughout childhood and into adulthood, with the child showing features of chronic inflammation of the respiratory tract.
V. GINA 2005 guidelines for the prevention and treatment of childhood asthma
The 2005 GINA program has a general understanding of asthma prevention and control in children: because children are at a different stage of growth and development, the effects and adverse effects of drugs used for the treatment and prevention of asthma are different from those of adults, and the younger they are, the faster they metabolize drugs including β2 agonists, inhaled hormones, and theophylline; inhaled glucocorticoids are currently considered the most effective control drugs, and their long-term use can significantly reduce the number and severity of asthma attacks. Long-term use of inhaled glucocorticosteroids does not increase osteoporosis or fractures, and follow-up studies of more than 3,500 children aged 1-13 years have not reported any sustained effects of inhaled glucocorticosteroids on growth and development; short-acting β2 agonists are the most effective drugs for relieving acute asthma attacks; once asthma is controlled, treatment needs to be maintained for at least 3 months, with gradual reduction in maintenance therapy.
Route of administration Asthma medications can be administered by inhalation, orally, subcutaneously, intramuscularly or intravenously. The advantages of direct respiratory drug delivery can effectively maintain the efficiency of the drug in the respiratory tract, but also to avoid or reduce the occurrence of systemic adverse reactions.
Select the appropriate inhalation device according to the different ages.
Table 1 Selection of inhalation devices for different ages
Age-appropriate devices Alternative devices
< 4 years of age with mask storage canister mask nebulizer inhalation
4 to 6 years of age storage canister with mouthpiece mask nebulized inhalation
> 6 years old dry powder inhaler with mouthpiece nebulized inhalation
2.Anti-asthma drugs include 2 types of anticholinergic drugs for rapid relief and long-term prevention.
(1) rapid relief drugs: including short-acting inhaled β2 agonists, short-acting oral β2 agonists, anticholinergic drugs, systemic corticosteroids, short-acting theophylline. Among them, β2 agonists are the most effective bronchodilators and are the drugs of choice for acute asthma attacks.
(2) Long-term preventive drugs: Inhaled glucocorticoids, long-acting inhaled and oral β2 agonists, anti-leukotrienes, sodium cromoglycate, nedocromil, systemic hormones, theophylline.
1) Inhaled hormones are currently the most effective control therapy for both school-age children and preschoolers and infants, but the role of long-term inhaled hormones in viral-induced wheezing is controversial. Systemic hormones are mainly used for acute asthma attacks and virus-induced wheezing.
Leukotriene modulators: Leukotriene modulators are new anti-asthma drugs, currently used in the treatment of asthma in children are mainly cysteine receptor antagonists, mainly used for moderate to severe persistent asthma that cannot be controlled by small doses of hormones.
Theophylline: Theophylline has limited application in the long-term treatment of asthma, but is still frequently used in some countries because of its low price. Extended-release theophylline can be used in mild asthma or in combination with inhaled hormones.
Long-acting inhaled β2 agonists: long-acting inhalation is mainly used in combination with inhaled hormones, and children can tolerate long-acting inhaled β2 agonists well; adverse effects of oral long-acting β2 agonists include cardiovascular stimulation, irritability, and skeletal muscle tremor.
GINA 2005 specific guidelines for the management of asthma in children
Asthma at any age, including children in the younger age groups, is a chronic inflammatory respiratory disease, and a stepwise treatment plan is advocated, with medications selected according to the severity of the child with asthma and an individualized prevention and treatment plan.
1.Guidelines for the treatment of asthma in children >5 years old
( 1) Intermittent asthma attacks: Inhaled β2 agonists with rapid action can be used as relieving drugs. Conventional control therapy, especially inhaled hormones, can be used in these children.
(2) Mild persistent asthma: Low-dose inhaled glucocorticoids (100-400 μg/d beclomethasone dipropionate) are recommended. Other treatments include extended-release theophylline, sodium cromoglycate, and leukotriene modifiers.
(3) Moderate persistent asthma: low to medium dose inhaled glucocorticoids (400-800 μg/d beclomethasone dipropionate) plus inhaled long-acting β2 agonist, other treatments include medium dose inhaled glucocorticoids plus extended-release theophylline, medium dose inhaled glucocorticoids plus oral long-acting β2 agonist, high dose inhaled glucocorticoids, or medium dose inhaled glucocorticoids plus leukotriene modifiers. Further studies are needed to compare the long-term efficacy of different combination treatments.
(4) Severe persistent asthma: inhaled high-dose glucocorticoids (> 800 μg/d beclomethasone dipropionate) plus inhaled long-acting β2 agonist, plus one or more of the following treatments if needed, including extended-release theophylline, leukotriene modulators, oral long-acting β2 agonists, oral hormones, or anti-IgE monoclonal antibodies.
Guidelines for the treatment of asthma in children <5 years of age There are no good clinical studies that provide optimal treatment for asthma in children <5 years of age of varying severity, and the regimens used are similar to those used in school-age children:
(1) Intermittent asthma attacks do not require specific treatment, and if intermittent asthma attacks develop into severe asthma attacks, they are treated as moderate persistent asthma. (2) Low-dose inhaled glucocorticoids (100-400 μg/d beclomethasone dipropionate) are recommended for mild persistent asthma. Other treatments include extended-release theophylline, sodium cromoglycate, and leukotriene modulators.
(3) Moderate persistent asthma with inhaled moderate dose glucocorticoids (400-800 μg/d beclomethasone dipropionate), other treatments include inhaled moderate dose glucocorticoids plus extended release theophylline, inhaled moderate dose glucocorticoids plus long-acting oral β2 agonists, high dose inhaled glucocorticoids, or moderate dose inhaled glucocorticoids plus leukotriene modifiers.
(4) Inhaled high-dose glucocorticoid (> 800μg/d beclomethasone dipropionate) plus inhaled long-acting β2 agonist for severe persistent asthma, and if needed, one or more of the following treatments, including extended-release theophylline, leukotriene modulators, long-acting oral β2 agonists, and oral hormones.
Asthma symptoms are fluctuating and variable, and inhaled hormones can reduce the severity of asthma in the long term. Once the asthma is controlled, the dosage will be gradually reduced to maintenance treatment after 3 months, so as to reduce the adverse effects of the drugs and to improve the compliance of the children and parents.