13.How should I treat an acute asthma attack? The treatment of an acute asthma attack depends on the severity of the attack and the response to treatment. The goal of treatment is to relieve symptoms, airflow limitation and hypoxemia as soon as possible, and also to develop a long-term treatment plan to prevent further acute attacks. Patients with high risk factors for asthma-related mortality require high priority and should be seen at the earliest possible time. Patients at high risk include: (1) a history of near-fatal asthma with tracheal intubation and mechanical ventilation; (2) hospitalization or emergency room visits for asthma in the past year; (3) current or recently discontinued oral hormone use; (4) not currently using inhaled hormones; (5) over-reliance on rapid-acting β2-agonists, especially if using more than 1 salbutamol (or equivalent) per month (6) psychological disorders or psychosocial problems, including sedation; (7) history of noncompliance with asthma treatment plans. Mild and some moderate acute exacerbations can be treated in the home or in the community. Treatment in the home or community is primarily with repeated inhalation of a rapid-acting β2-agonist, 2 to 4 sprays every 20 min in the first hour. Subsequently, depending on the response to treatment, mild acute attacks can be adjusted to 2-4 sprays every 3-4 h, and moderate acute attacks to 6-10 sprays every 1 to 2 h. If the response to inhaled β2-agonists is good (significant relief of dyspnea, PEF >80% of expected value or personal best, and efficacy maintained for 3 to 4 h), no other medication is usually required. If the response to therapy is incomplete, especially in acute attacks occurring on the basis of controlled therapy, oral hormones (prednisolone 0.5 to 1 mg/kg or equivalent doses of other hormones) should be administered as early as possible, and hospital visits should be made if necessary. Some moderate and all severe acute attacks should be treated in the emergency room or hospital. In addition to oxygen therapy, a rapid-acting β2-agonist should be repeated, either administered through a pressure-dosing aerosol reservoir or through a jet nebulization device. The drug is administered continuously by nebulization during initial therapy and subsequently intermittently (every 4 hours) as needed. There is no evidence to support the routine intravenous use of β2 agonists. Better bronchodilatory effects are achieved with the combination of β2-agonists and anticholinergic agents (e.g., ipratropium bromide). The bronchodilatory effect of theophylline is weaker than that of SABA and should be used with caution due to greater adverse effects. Theophylline blood levels should be monitored as much as possible in patients taking theophylline extended-release preparations intravenously. Systemic hormones should be used as early as possible in acute attacks of moderate to severe asthma, especially in patients with incomplete response to initial treatment with rapid-acting β2-agonists or whose efficacy cannot be maintained, and in patients who still have acute attacks on the basis of oral hormones. Oral hormones are comparable in efficacy to intravenous administration and have fewer side effects. Dosage: Prednisolone 30-50 mg or equivalent other hormone, given as a single daily dose. In severe acute attacks or when oral hormone cannot be tolerated, intravenous injection or drip can be used, such as methylprednisolone 80-160mg, or hydrocortisone 400-1000mg given in divided doses. Dexamethasone is generally not recommended because of its long half-life and strong inhibitory effect on adrenal cortical function. Sequential therapy of intravenous and oral administration has the potential to reduce hormone dosage and adverse effects, such as intravenous hormones for 2-3 d, followed by oral hormones for 3-5 d. After acute attacks of severe and critical asthma treated with the above drugs, clinical symptoms and pulmonary function do not improve or even continue to deteriorate, prompt mechanical ventilation should be given. mmHg (1mmHg=0.133kPa), etc. Non-invasive mechanical ventilation via nasal (face) mask can be used first, and if there is no effect, early mechanical ventilation by tracheal intubation can be performed. Mechanical ventilation for acute asthma exacerbation requires high inspiratory pressure and can be treated with appropriate levels of positive end-expiratory pressure (PEEP). If excessive peak and plateau airway pressures are required to maintain normal ventilation volumes, a permissive hypercapnic ventilation strategy may be tried to reduce ventilator-associated lung injury. Those with significant symptomatic improvement with initial treatment and PEF or FEV1 % of expected value recovered to or above 60% of personal best may go home for continued treatment, those with PEF or FEV1 of 40% to 60% should return to home or community under supervision for continued treatment, and those with PEF or FEV1 <25%< span=""> before treatment or <40%< span=""> after treatment should be admitted to hospital. At discharge or at recent follow-up, a detailed action plan should be developed to audit the patient for proper use of medications, inhalation devices, and peak flowmeters, to identify triggers of acute exacerbations and develop measures to avoid exposure, and to adjust the controlled treatment regimen. Severe acute asthma attacks mean failure of asthma management and these patients should be given close monitoring, long-term follow-up, and long-term asthma education. Most acute asthma attacks are not caused by bacterial infections, and indications for the use of antimicrobial drugs should be strictly controlled unless there is evidence of bacterial infection, or they are severe or critical acute asthma attacks. 14. Do patients with asthma need treatment when they are not having an attack? The root cause of asthma is mainly due to long-term non-specific inflammation in the bronchial tubes, which is not caused by bacterial or viral infections and can currently only be effectively controlled by long-term regular inhaled hormones. However, during the treatment process, patients often stop treatment as soon as their symptoms are relieved or after a period of time without attacks, thinking that occasional cough and shortness of breath are not considered serious, resulting in recurrent attacks, leading to the destruction of airway structures and causing permanent lung function damage. The most important prevention and treatment strategy for asthma is preventive treatment, which means not waiting for an attack to occur, but rather not letting it happen, and the fewer the attacks, the better. Regardless of whether there are symptoms or not, patients need to adhere to regular follow-up and long-term regular treatment under the guidance of a physician in order to achieve complete control of asthma. 15.Do asthma patients have to use hormones? Does long-term use of hormones have any effect on the body? The basic treatment of asthma mainly includes hormone inhalation, because through repeated research over the years, it has been determined that asthma is a chronic inflammation of the airways, which causes hyperresponsiveness of the airways, wheezing, airway constriction and other symptoms. Hormones are by far the best treatment method. For milder cases, hormone inhalation alone can be used, while for more severe cases, hormone and long-acting beta-agonist can be used in combination to achieve control effect. For patients with severe disease, systemic hormone therapy is used; some patients rely excessively on oral hormones, which are fast-acting, but because they are systemic drugs, they are easy to cause side effects such as elevated blood glucose and osteoporosis after long-term mass consumption, which are more harmful compared to the local use of inhalants. These irregular treatments lead to impaired lung function in many patients and the formation of refractory asthma. Studies have confirmed that inhaled corticosteroids are safe and can be used by patients on a long-term basis. The adverse effects of inhaled hormones are mild, mainly some local reactions, such as hoarseness and Candida infection in the oropharynx, which can be avoided by using a storage mist canister and gargling after medication. 16.What about recurrent asthma attacks? Asthma is a common and frequent chronic respiratory disease. The root cause of asthma is mainly due to long-term non-specific inflammation in the bronchial tubes, which is not caused by bacterial or viral infections and can only be effectively controlled by long-term regular inhalation of hormones at present. During the treatment process, patients and family members often only see the change of symptoms, but ignore the persistence of this non-specific inflammation, and actively stop the treatment once the symptoms are relieved, so that the non-specific inflammation is out of control, resulting in recurrent attacks. This causes considerable pain and burden not only to the patients themselves but also to their families. It is recommended that asthma patients need to adhere to long-term regular treatment to continuously control the non-specific inflammation of the bronchial tubes and solve the problem from the etiology, so as to achieve complete control of asthma and improve the quality of life. 17.What is stepwise treatment of asthma? Step therapy for asthma means choosing the appropriate treatment plan according to the degree of the condition during the non-acute exacerbation of asthma. The treatment plan must be individualized and applied in combination, with the principle of the smallest amount and the simplest combination with the least side effects to achieve the best control of symptoms. The condition will be evaluated every 3-6 months and then the treatment plan will be adjusted, or escalated or downgraded according to the condition. If asthma is not controlled, the treatment level should be upgraded to achieve asthma control, and if control is achieved and maintained for more than 3 months, the treatment level should be downgraded, with the ultimate goal of achieving asthma control with the lowest dose of medication and the lowest treatment level. 18.Can asthma patients take Chinese medicine for treatment? The purpose of treatment for asthma patients is mainly to enable patients in acute exacerbation to be relieved of symptoms quickly; to enable patients in remission to prevent recurrence effectively. Chinese medicine also has a certain therapeutic effect in the treatment of asthma, and should be used as the main treatment for the remission, consolidation and prevention of recurrence of the disease.